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General NPI Number Information
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NPI Number | 1811774037
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Entity Type | Individual
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Provider Name | JORDAN NICOLE BEACH
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1500 N CLYBOURN AVE UNIT C105
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City | CHICAGO
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State | IL
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Zip | 60610-2295
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Country | US
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Telephone | 312-242-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 34755 COUNTY ROAD 10
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City | KEENESBURG
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State | CO
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Zip | 80643-8526
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Country | US
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Telephone | 970-381-2869
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | A.B.61477567
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CBT.CB.61472697
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-78117
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License Number State | CO
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