MEDICARE: JALANDA MONANNIQUE JORDAN LCSW

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	1041C0700X	Clinical Social Worker	CSW007220	GA

General Provider Information

NPI Number	:	1346875036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALANDA MONANNIQUE JORDAN LCSW

Provider Business Mailing Address
First Line	:	604 BURTONS CV
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3182
Country	:	US
Telephone Number	:	678-851-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 BURTONS CV
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3182
Country	:	US
Telephone Number	:	678-437-9987
Fax Number	:

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	01/27/2026

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