Provider Demographics
NPI:1417983354
Name:JORDAN, JOYCE TAYLOR (LISW-S, LICDC, SAP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:TAYLOR
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LISW-S, LICDC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 DETROIT AVENUE
Mailing Address - Street 2:SUITE #LL40
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-226-2721
Mailing Address - Fax:216-226-2731
Practice Address - Street 1:14650 DETROIT AVENUE
Practice Address - Street 2:SUITE #LL30
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-226-2721
Practice Address - Fax:216-226-2731
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00093841041C0700X
OHI00093841041C0700X
OH9543551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632431Medicaid
OH2632431Medicaid