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General NPI Number Information
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NPI Number | 1891089470
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Entity Type | Individual
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Provider Name | SHANNON R. JORDAN LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 6726A INDUSTRIAL DR
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City | BELTSVILLE
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State | MD
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Zip | 20705-1237
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Country | US
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Telephone | 410-756-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 10125 COLESVILLE RD STE 204
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City | SILVER SPRING
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State | MD
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Zip | 20901-2457
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Country | US
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Telephone | 410-756-0477
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079110
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License Number State | DC
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