Provider Demographics
NPI:1659045870
Name:BONNER, JORDAN ELIZABETH (MA NCC CATP CCTP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:BONNER
Suffix:
Gender:F
Credentials:MA NCC CATP CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15692-1279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 ALWINE AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3209
Practice Address - Country:US
Practice Address - Phone:412-610-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health