Provider Demographics
NPI:1235831413
Name:JORDAN, NICOLE (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MISSION RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1319
Mailing Address - Country:US
Mailing Address - Phone:913-735-0577
Mailing Address - Fax:
Practice Address - Street 1:262 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:913-735-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical