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General NPI Number Information
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NPI Number | 1255941225
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Entity Type | Individual
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Provider Name | JORDAN BERRY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 13851 W 63RD ST # 181
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City | SHAWNEE
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State | KS
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Zip | 66216-3800
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Country | US
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Telephone | 480-420-9397
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Fax | 602-926-7377
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Provider Business Mailing Address
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Address Line | 13851 W 63RD ST # 181
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City | SHAWNEE
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State | KS
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Zip | 66216-3800
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Country | US
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Telephone | 480-420-9397
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Fax | 602-926-7377
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-19263
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2024038897
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06440
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License Number State | KS
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