MEDICARE: MRS. LYNN ANNE 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	LFSW 0001658	FL

General Provider Information

NPI Number	:	1841361987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN ANNE JORDAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 412
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34991-0412
Country	:	US
Telephone Number	:	772-233-2354
Fax Number	:	772-288-2884

Provider Business Practice Location Address
First Line	:	614 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4750
Country	:	US
Telephone Number	:	772-233-2354
Fax Number	:	772-225-1226

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/08/2007

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