MEDICARE: RONIA JORDAN

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	104100000X	Social Worker	LMSW-45322	ID

General Provider Information

NPI Number	:	1740071554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONIA JORDAN

Provider Business Mailing Address
First Line	:	PO BOX 5222
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-0222
Country	:	US
Telephone Number	:	208-590-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 W FRANKLIN ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5024
Country	:	US
Telephone Number	:	208-590-3218
Fax Number	:	888-261-8114

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	06/15/2026

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Directions to “ RONIA JORDAN ” Practice Location

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