Provider Demographics
NPI:1114453073
Name:JORDAN, KELSEY JEAN (MA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JEAN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 19TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4248
Mailing Address - Country:US
Mailing Address - Phone:402-606-3084
Mailing Address - Fax:402-606-4693
Practice Address - Street 1:3005 19TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4248
Practice Address - Country:US
Practice Address - Phone:402-606-3084
Practice Address - Fax:402-606-4693
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist