Provider Demographics
NPI:1174840995
Name:JORDAN, JENNIFER LYNNE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
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 1:90 CHERRYVILLE STANTON RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5563
Mailing Address - Country:US
Mailing Address - Phone:908-310-6098
Mailing Address - Fax:
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3104
Practice Address - Country:US
Practice Address - Phone:732-290-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ594462101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool