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NPI Code Detail

MEDICARE: JORDAN RAY

MEDICARE: JORDAN RAY
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
1103K00000XBehavior Analyst152.003363IL

General Provider Information

NPI Number : 1669042578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN RAY
Provider Business Mailing Address
First Line : 4123 W BELLE PLAINE AVE APT 19
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2469
Country : US
Telephone Number : 801-691-8653
Fax Number :
Provider Business Practice Location Address
First Line : 5960 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60646-5424
Country : US
Telephone Number : 224-243-4819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2021
Last Update Date : 06/12/2026

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Directions to “ JORDAN RAY ” Practice Location

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