MEDICARE: SYDNEY JORDAN CT

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	101YM0800X	Mental Health Counselor	C.2406013-TRNE	OH

General Provider Information

NPI Number	:	1275364309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY JORDAN CT

Provider Business Mailing Address
First Line	:	4547 FISHCREEK RD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-2146
Country	:	US
Telephone Number	:	740-244-2137
Fax Number	:

Provider Business Practice Location Address
First Line	:	3918 CLOCK POINTE TRL STE 103
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-2989
Country	:	US
Telephone Number	:	216-839-2273
Fax Number	:

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

Provider Enumeration Date	:	08/10/2024
Last Update Date	:	08/10/2024

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Directions to “ SYDNEY JORDAN CT” Practice Location

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