Provider Demographics
NPI:1568143360
Name:JONES, JORDYN BREE-ANN (PSS)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:BREE-ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 NE JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3311
Mailing Address - Country:US
Mailing Address - Phone:541-580-3745
Mailing Address - Fax:
Practice Address - Street 1:548 SE JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4983
Practice Address - Country:US
Practice Address - Phone:541-229-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103934175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist