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General NPI Number Information
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NPI Number | 1841338209
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Entity Type | Individual
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Provider Name | JENNIFER JORDAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE STE 202
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City | CORONA
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State | CA
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Zip | 92879-3144
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Country | US
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Telephone | 951-520-3854
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Fax | 951-298-9367
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Provider Business Mailing Address
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Address Line | 659 VIEW LN
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City | CORONA
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State | CA
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Zip | 92881-8347
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Country | US
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Telephone | 951-520-3854
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT52413
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License Number State | CA
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