Provider Demographics
NPI:1598980898
Name:JORDEN, JOHN CLYDE (DMIN, MED)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLYDE
Last Name:JORDEN
Suffix:
Gender:M
Credentials:DMIN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2826
Mailing Address - Country:US
Mailing Address - Phone:419-565-1040
Mailing Address - Fax:419-281-6900
Practice Address - Street 1:930 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3741
Practice Address - Country:US
Practice Address - Phone:419-289-8100
Practice Address - Fax:419-281-6999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist