Provider Demographics
NPI:1750024311
Name:IOSUE, JORDAN ASHLEY
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY
Last Name:IOSUE
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 1:424 HOUND HILL PL
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2135
Mailing Address - Country:US
Mailing Address - Phone:901-679-7632
Mailing Address - Fax:
Practice Address - Street 1:326 PATTERSON HALL # 113
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3510
Practice Address - Country:US
Practice Address - Phone:901-678-2841
Practice Address - Fax:901-678-5114
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool