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General NPI Number Information
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NPI Number | 1417359209
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Entity Type | Individual
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Provider Name | LINDA JORDAN CMHT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 4025 N 92ND ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-1613
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Country | US
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Telephone | 601-494-9524
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 N 92ND ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-1613
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Country | US
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Telephone | 601-494-9524
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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 | 2040
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2040
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License Number State | MS
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