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General NPI Number Information
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NPI Number | 1346796984
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Entity Type | Individual
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Provider Name | JORDAN YAGIELA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1940 LUDINGTON STREET
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City | WYANDOTTE
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State | MI
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Zip | 48192
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Country | US
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Telephone | 734-484-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 32 N WASHINGTON ST SUITE 1
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City | YPSILANTI
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State | MI
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Zip | 48197-2662
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Country | US
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Telephone | 248-763-5248
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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