Provider Demographics
NPI:1235861097
Name:CATLETT, JORDAN (CSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CATLETT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1112
Mailing Address - Country:US
Mailing Address - Phone:605-430-1989
Mailing Address - Fax:
Practice Address - Street 1:5024 S BUR OAK PL STE 208
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2238
Practice Address - Country:US
Practice Address - Phone:605-274-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker