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General NPI Number Information
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NPI Number | 1134447105
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE JORDAN MSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 1117 N JACKSON ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3385
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Country | US
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Telephone | 812-361-8568
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Fax | 812-339-2932
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Provider Business Mailing Address
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Address Line | 1117 N JACKSON ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3385
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Country | US
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Telephone | 812-361-8568
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Fax | 812-339-2932
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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