Provider Demographics
NPI:1962688143
Name:JORDAN, BRANDI (MSW, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSW, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039
Mailing Address - Country:US
Mailing Address - Phone:323-662-0100
Mailing Address - Fax:323-662-0101
Practice Address - Street 1:3042 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039
Practice Address - Country:US
Practice Address - Phone:323-662-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231341041C0700X
11240304174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN