Provider Demographics
NPI:1194457192
Name:PAUL, JORDYN MARIE
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:MARIE
Last Name:PAUL
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 1:5989 WEISS ST APT L05
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2713
Mailing Address - Country:US
Mailing Address - Phone:810-834-2407
Mailing Address - Fax:
Practice Address - Street 1:900 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6189
Practice Address - Country:US
Practice Address - Phone:989-778-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician