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General NPI Number Information
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NPI Number | 1598980898
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Entity Type | Individual
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Provider Name | JOHN CLYDE JORDEN D.MIN, M.ED.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 930 CLAREMONT AVE
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City | ASHLAND
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State | OH
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Zip | 44805-3741
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Country | US
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Telephone | 419-289-8100
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Fax | 419-281-6999
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Provider Business Mailing Address
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Address Line | 1793 S MAIN ST
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City | MANSFIELD
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State | OH
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Zip | 44907-2826
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Country | US
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Telephone | 419-565-1040
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Fax | 419-281-6900
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2611
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License Number State | OH
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