Provider Demographics
NPI:1831649532
Name:DAVIS, JORDAN KATHERINE (BA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:KATHERINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6012
Mailing Address - Country:US
Mailing Address - Phone:989-778-1396
Mailing Address - Fax:989-778-1394
Practice Address - Street 1:1005 3RD ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6012
Practice Address - Country:US
Practice Address - Phone:989-778-1396
Practice Address - Fax:989-778-1394
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator