Provider Demographics
NPI:1508551268
Name:REYNOLDS, JORDAN NICOLE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:NICOLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N SELFRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1011
Mailing Address - Country:US
Mailing Address - Phone:248-705-2042
Mailing Address - Fax:
Practice Address - Street 1:1501 N SELFRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1011
Practice Address - Country:US
Practice Address - Phone:248-705-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011159451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical