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NPI Code Detail

MEDICARE: JORDYN PIERCE

MEDICARE: JORDYN PIERCE
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 TechnicianCDCA.172222OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA-175948OH

General Provider Information

NPI Number : 1285259804
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN PIERCE
Provider Business Mailing Address
First Line : 2400 W STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45439-2041
Country : US
Telephone Number : 937-951-1772
Fax Number :
Provider Business Practice Location Address
First Line : 2400 W STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45439-2041
Country : US
Telephone Number : 937-951-1772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2020
Last Update Date : 03/19/2024

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