Provider Demographics
NPI:1700281060
Name:BAILEY, JORDAN DANIEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:DANIEL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4148
Mailing Address - Country:US
Mailing Address - Phone:616-745-9329
Mailing Address - Fax:
Practice Address - Street 1:1832 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4148
Practice Address - Country:US
Practice Address - Phone:616-745-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-10244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst