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General NPI Number Information
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NPI Number | 1073017281
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Entity Type | Individual
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Provider Name | HEATHER ROSE JORDAN LPC
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Gender | Female
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 300 68TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49548-6927
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Country | US
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Telephone | 616-258-7467
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Fax | 616-258-7432
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Provider Business Mailing Address
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Address Line | 2460 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4801
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Country | US
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Telephone | 616-309-0737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006787
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401018307
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License Number State | MI
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