Provider Demographics
NPI:1598532350
Name:DAGER, JORDAN MC KENZIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MC KENZIE
Last Name:DAGER
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 1:15674 COBBS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-9430
Mailing Address - Country:US
Mailing Address - Phone:419-386-9853
Mailing Address - Fax:
Practice Address - Street 1:14701 CUMBERLAND RD STE 170
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-8715
Practice Address - Country:US
Practice Address - Phone:419-386-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010833A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical