Provider Demographics
NPI:1710631155
Name:BARBAN-JOURDAN, WENDY (BEHAVIOR THERAPIST)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BARBAN-JOURDAN
Suffix:
Gender:F
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21164 N RICHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-8523
Mailing Address - Country:US
Mailing Address - Phone:618-214-0034
Mailing Address - Fax:
Practice Address - Street 1:400 S ELM ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3910
Practice Address - Country:US
Practice Address - Phone:618-532-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst