Provider Demographics
NPI:1639615321
Name:STRICKLEN, JORDAN DANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DANIEL
Last Name:STRICKLEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HARTFIELD DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7707
Mailing Address - Country:US
Mailing Address - Phone:616-401-6578
Mailing Address - Fax:
Practice Address - Street 1:833 KENMOOR AVE SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2390
Practice Address - Country:US
Practice Address - Phone:616-551-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004119103T00000X
MI6301018878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist