Provider Demographics
NPI:1275029795
Name:JORDAN, KARIN (LCDCIII)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2443
Mailing Address - Country:US
Mailing Address - Phone:216-231-7700
Mailing Address - Fax:216-231-3828
Practice Address - Street 1:9127 MILES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6136
Practice Address - Country:US
Practice Address - Phone:216-325-6544
Practice Address - Fax:216-441-3968
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.031047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)