Provider Demographics
NPI:1013343706
Name:WILLER, JORDAN
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:WILLER
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 1:4504 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-1135
Mailing Address - Country:US
Mailing Address - Phone:402-360-0055
Mailing Address - Fax:
Practice Address - Street 1:3901 W NORFOLK AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-9222
Practice Address - Country:US
Practice Address - Phone:402-360-0055
Practice Address - Fax:402-844-8046
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
2104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor