MEDICARE: KELSEY JEAN JORDAN M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	11142	NE

General Provider Information

NPI Number	:	1114453073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY JEAN JORDAN M.A.

Provider Business Mailing Address
First Line	:	3005 19TH ST
Second Line	:	SUITE 700
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4248
Country	:	US
Telephone Number	:	402-606-3084
Fax Number	:	402-606-4693

Provider Business Practice Location Address
First Line	:	3005 19TH ST
Second Line	:	SUITE 700
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4248
Country	:	US
Telephone Number	:	402-606-3084
Fax Number	:	402-606-4693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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