Provider Demographics
NPI:1558482349
Name:JORDAN, HANNA A (LCSW)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:A
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 1:4225 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1313
Mailing Address - Country:US
Mailing Address - Phone:503-299-4754
Mailing Address - Fax:503-299-4754
Practice Address - Street 1:4225 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1313
Practice Address - Country:US
Practice Address - Phone:503-299-4754
Practice Address - Fax:503-299-4754
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid
OROOOOWCQLVMedicare ID - Type Unspecified