Provider Demographics
NPI:1215662093
Name:RODAK, JOURDAN ALEXANDER
Entity type:Individual
Prefix:DR
First Name:JOURDAN
Middle Name:ALEXANDER
Last Name:RODAK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2245
Mailing Address - Country:US
Mailing Address - Phone:904-434-4544
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR STE 205
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1424
Practice Address - Country:US
Practice Address - Phone:954-378-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical