MEDICARE: JORDYN WOOD-HARRIS

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	101YP2500X	Professional Counselor	2023023598	MO

General Provider Information

NPI Number	:	1982486874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDYN WOOD-HARRIS

Provider Business Mailing Address
First Line	:	255 CHEROKEE DR APT 28
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W MAIN ST STE 200
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3743
Country	:	US
Telephone Number	:	816-427-1337
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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Directions to “ JORDYN WOOD-HARRIS ” Practice Location

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