Provider Demographics
NPI:1083247290
Name:JORDAN, JATNNA MERIBETH
Entity Type:Individual
Prefix:
First Name:JATNNA
Middle Name:MERIBETH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HARRINGTON AVE UNIT 4108
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5285
Mailing Address - Country:US
Mailing Address - Phone:978-382-1627
Mailing Address - Fax:
Practice Address - Street 1:695 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7076
Practice Address - Country:US
Practice Address - Phone:978-382-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician