Provider Demographics
NPI:1508696998
Name:JORDAN, DELAURA A
Entity type:Individual
Prefix:MISS
First Name:DELAURA
Middle Name:A
Last Name:JORDAN
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 1:4744 ROSE ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-1541
Mailing Address - Country:US
Mailing Address - Phone:773-969-2850
Mailing Address - Fax:
Practice Address - Street 1:5420 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1800
Practice Address - Country:US
Practice Address - Phone:708-667-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician