Provider Demographics
NPI:1477118321
Name:WALSH, JORDAN (CSW-PIP, LCSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:CSW-PIP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-5200
Mailing Address - Fax:
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5200
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172331041C0700X
SD36071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty