Provider Demographics
NPI:1780496935
Name:EASTERLIN, JORDAN TAYLOR
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TAYLOR
Last Name:EASTERLIN
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 1:5231 W PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9425
Mailing Address - Country:US
Mailing Address - Phone:414-331-2781
Mailing Address - Fax:
Practice Address - Street 1:335 WRIGLEY DR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2034
Practice Address - Country:US
Practice Address - Phone:414-331-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health