Provider Demographics
NPI:1396130266
Name:HARDVAL, JORDAN (EDS, MED, BA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HARDVAL
Suffix:
Gender:F
Credentials:EDS, MED, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 SUTTON AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1669
Mailing Address - Country:US
Mailing Address - Phone:330-978-9233
Mailing Address - Fax:
Practice Address - Street 1:1040 GASKINS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2746
Practice Address - Country:US
Practice Address - Phone:513-947-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151590103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool