Provider Demographics
NPI:1942645353
Name:JORDAN, BROOKE TAYLOR (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:TAYLOR
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12726 HAMILTON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5422
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:317-249-2248
Practice Address - Street 1:11450 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4688
Practice Address - Country:US
Practice Address - Phone:317-689-7850
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-13-13329103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst