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General NPI Number Information
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NPI Number | 1275101461
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Entity Type | Individual
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Provider Name | CHARLOTTE ROSE JORDAN
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 1315 S BELL AVE STE 108
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City | AMES
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State | IA
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Zip | 50010-7730
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Country | US
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Telephone | 515-337-0343
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 ASPEN RD UNIT 105
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City | AMES
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State | IA
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Zip | 50010-4092
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Country | US
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Telephone | 515-494-2434
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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