Provider Demographics
NPI:1578985768
Name:WHITE, JORDAN PRAGER
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PRAGER
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N NORTH CT STE 272
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8105
Mailing Address - Country:US
Mailing Address - Phone:224-436-7392
Mailing Address - Fax:
Practice Address - Street 1:410 S MICHIGAN AVE STE 928
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1399
Practice Address - Country:US
Practice Address - Phone:312-248-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker