Provider Demographics
NPI:1275260788
Name:YONCE, JORDAN SYDNEY (BS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SYDNEY
Last Name:YONCE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JORDAB
Other - Middle Name:ERIN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4113 BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:MARSING
Mailing Address - State:ID
Mailing Address - Zip Code:83639-8072
Mailing Address - Country:US
Mailing Address - Phone:970-631-4782
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4969
Practice Address - Country:US
Practice Address - Phone:510-268-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician