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NPI Code Detail

MEDICARE: JORDAN MICHELLE HENDRICKSON PSYD

MEDICARE: JORDAN MICHELLE HENDRICKSON PSYD
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
1103TC0700XClinical PsychologistPY60949986WA
2103TC0700XClinical PsychologistPSYPSYLIC3612MT
3103TC0700XClinical Psychologist2608OR

General Provider Information

NPI Number : 1437452018
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MICHELLE HENDRICKSON PSYD
Provider Business Mailing Address
First Line : 4400 NE 77TH AVE STE 275
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-6857
Country : US
Telephone Number : 503-709-3295
Fax Number :
Provider Business Practice Location Address
First Line : 4400 NE 77TH AVE STE 275
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-6857
Country : US
Telephone Number : 503-709-3295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2010
Last Update Date : 09/28/2021

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