Provider Demographics
NPI:1689169831
Name:LAUGHLIN, JORDYN TAYLOR
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:TAYLOR
Last Name:LAUGHLIN
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 1:2962 SERFASS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9369
Mailing Address - Country:US
Mailing Address - Phone:330-546-2290
Mailing Address - Fax:
Practice Address - Street 1:2962 SERFASS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-9369
Practice Address - Country:US
Practice Address - Phone:330-546-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator