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General NPI Number Information
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NPI Number | 1811054224
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Entity Type | Individual
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Provider Name | GLORY JORDAN LCSW, DCSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1 TIFFANY PT SUITE 203
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2936
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Country | US
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Telephone | 630-924-0600
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Fax | 866-808-2485
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Provider Business Mailing Address
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Address Line | 1 TIFFANY PT SUITE 203
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2936
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Country | US
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Telephone | 630-924-0600
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Fax | 630-206-3019
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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 | 149.002321
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License Number State | IL
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