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NPI Code Detail

MEDICARE: HALLIE ELIZABETH JORDAN BCBA

MEDICARE: HALLIE ELIZABETH JORDAN BCBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1235608613
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALLIE ELIZABETH JORDAN BCBA
Provider Business Mailing Address
First Line : 187 ASHLEY WOODS CT
Second Line :
City : CLAYTON
State : NC
Zip : 27527-9333
Country : US
Telephone Number : 919-631-9264
Fax Number :
Provider Business Practice Location Address
First Line : 115 W NASHVILLE DR
Second Line :
City : NASHVILLE
State : NC
Zip : 27856-1284
Country : US
Telephone Number : 919-631-9264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2018
Last Update Date : 05/08/2024

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