MEDICARE: JORDAN FORRE

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	106S00000X	Behavior Technician	RBT-18-73691	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669957957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN FORRE

Provider Business Mailing Address
First Line	:	2601 NE 37TH DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6324
Country	:	US
Telephone Number	:	954-294-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 NE 37TH DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6324
Country	:	US
Telephone Number	:	954-294-4651
Fax Number	:

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	07/07/2019

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Directions to “ JORDAN FORRE ” Practice Location

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