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NPI Code Detail

MEDICARE: JORDYN BACHMAN LSW

MEDICARE: JORDYN BACHMAN LSW
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
11041C0700XClinical Social WorkerS.2309789OH

General Provider Information

NPI Number : 1154195188
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN BACHMAN LSW
Provider Business Mailing Address
First Line : 7774 WELLSBURY DR
Second Line :
City : WATERVILLE
State : OH
Zip : 43566-1702
Country : US
Telephone Number : 419-376-7455
Fax Number :
Provider Business Practice Location Address
First Line : 4352 W SYLVANIA AVE STE A
Second Line :
City : TOLEDO
State : OH
Zip : 43623-3441
Country : US
Telephone Number : 419-561-5433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2023
Last Update Date : 11/09/2023

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