Provider Demographics
NPI:1508914714
Name:JORDAN, DEBORAH ANN (MED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVE
Mailing Address - Street 2:SUITE 1121
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4443
Mailing Address - Country:US
Mailing Address - Phone:253-272-9762
Mailing Address - Fax:
Practice Address - Street 1:1019 PACIFIC AVE
Practice Address - Street 2:SUITE 1121
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4443
Practice Address - Country:US
Practice Address - Phone:253-272-9762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health