MEDICARE: MS. YOLANDA 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	149008481	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	273966000	OTHER	IL	MAGELLAN EAP
2	0001633569	OTHER	IL	BLUE CROSS BLUE SHIELD
3	367262	OTHER	IL	MBC CORPORATION

General Provider Information

NPI Number	:	1457457897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YOLANDA JORDAN LCSW

Provider Business Mailing Address
First Line	:	454 SPRINGWOOD LN
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-1476
Country	:	US
Telephone Number	:	630-248-1926
Fax Number	:	773-233-9248

Provider Business Practice Location Address
First Line	:	10540 S WESTERN AVE
Second Line	:	SUITE 313
City	:	CHICAGO
State	:	IL
Zip	:	60643-2536
Country	:	US
Telephone Number	:	773-239-7450
Fax Number	:	773-233-9248

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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