Provider Demographics
NPI:1588024020
Name:JORDAN, SARAH GRACE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 ROCKLIN RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2862
Mailing Address - Country:US
Mailing Address - Phone:916-779-2455
Mailing Address - Fax:
Practice Address - Street 1:4240 ROCKLIN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2862
Practice Address - Country:US
Practice Address - Phone:916-779-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst