Provider Demographics
NPI:1326522020
Name:CATANDELLA, JORDYN K
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:K
Last Name:CATANDELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:
Other - Last Name:YAMANOHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 W MARBETH CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4935
Mailing Address - Country:US
Mailing Address - Phone:503-686-9398
Mailing Address - Fax:
Practice Address - Street 1:3025 W MARBETH CT
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4935
Practice Address - Country:US
Practice Address - Phone:503-686-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60889018106S00000X
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician