Provider Demographics
NPI:1093798589
Name:JORDAN, ROSEMARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6549
Mailing Address - Country:US
Mailing Address - Phone:563-243-6054
Mailing Address - Fax:563-243-6828
Practice Address - Street 1:2100 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6366
Practice Address - Country:US
Practice Address - Phone:309-797-2900
Practice Address - Fax:309-797-2417
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2019-03-27
Deactivation Date:2006-02-01
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IL1490089681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31453Medicare UPIN