Provider Demographics
NPI:1255834289
Name:CROFT, JORDAN T (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:T
Last Name:CROFT
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:TAYLOR
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:495 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5349
Practice Address - Country:US
Practice Address - Phone:614-355-8080
Practice Address - Fax:614-355-8056
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid