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NPI Code Detail

MEDICARE: ANDREW J JORDAN SSW

MEDICARE: ANDREW J JORDAN SSW
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
1104100000XSocial Worker12680519-3503UT

General Provider Information

NPI Number : 1891589610
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW J JORDAN SSW
Provider Business Mailing Address
First Line : 12760 S PARK AVE UNIT 520
Second Line :
City : RIVERTON
State : UT
Zip : 84065-3422
Country : US
Telephone Number : 801-407-0047
Fax Number : 888-400-9232
Provider Business Practice Location Address
First Line : 12760 S PARK AVE UNIT 520
Second Line :
City : RIVERTON
State : UT
Zip : 84065-3422
Country : US
Telephone Number : 801-407-0047
Fax Number : 888-400-9232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2025
Last Update Date : 04/07/2025

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