Provider Demographics
NPI:1407518046
Name:JORDAN, KENDRA CAROLINE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:CAROLINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 LOWE CT APT 3C
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4052
Mailing Address - Country:US
Mailing Address - Phone:347-761-9718
Mailing Address - Fax:
Practice Address - Street 1:14815 LOWE CT APT 3C
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4052
Practice Address - Country:US
Practice Address - Phone:347-761-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency