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NPI Code Detail

MEDICARE: KIMBERLY GARDNER JORDAN MCLEOD MSW

MEDICARE: KIMBERLY GARDNER JORDAN MCLEOD MSW
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
1106E00000XAssistant Behavior Analyst0134000663VA

General Provider Information

NPI Number : 1255810081
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY GARDNER JORDAN MCLEOD MSW
Provider Business Mailing Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Provider Business Practice Location Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 01/09/2026

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