Provider Demographics
NPI:1184167959
Name:JORDAN, HILARY (CMT, MA)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CMT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5631
Mailing Address - Country:US
Mailing Address - Phone:530-210-6592
Mailing Address - Fax:
Practice Address - Street 1:144 HUGHES RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5631
Practice Address - Country:US
Practice Address - Phone:530-210-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist