Provider Demographics
NPI:1457457897
Name:JORDAN, YOLANDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1476
Mailing Address - Country:US
Mailing Address - Phone:630-248-1926
Mailing Address - Fax:773-233-9248
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:773-239-7450
Practice Address - Fax:773-233-9248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490084811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273966000OtherMAGELLAN EAP
IL0001633569OtherBLUE CROSS BLUE SHIELD
IL367262OtherMBC CORPORATION