Provider Demographics
NPI:1649859455
Name:JORDAN, SYLVIA C (LISW-S)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:C
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ELDERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2882
Mailing Address - Country:US
Mailing Address - Phone:419-961-8502
Mailing Address - Fax:
Practice Address - Street 1:129 ELDERBERRY DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2882
Practice Address - Country:US
Practice Address - Phone:141-996-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22035671041C0700X
OHS.2106013104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker