Provider Demographics
NPI:1811054224
Name:JORDAN, GLORY (LCSW, DCSW)
Entity type:Individual
Prefix:MS
First Name:GLORY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:GLORY
Other - Middle Name:
Other - Last Name:FRIDDELL-JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, DCSW
Mailing Address - Street 1:1 TIFFANY PT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2936
Mailing Address - Country:US
Mailing Address - Phone:630-924-0600
Mailing Address - Fax:630-206-3019
Practice Address - Street 1:1 TIFFANY PT
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2936
Practice Address - Country:US
Practice Address - Phone:630-924-0600
Practice Address - Fax:866-808-2485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0023211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL262945OtherVALUE OPTIONS PROVIDER NO
IL363716771OtherTAX ID
IL7435198OtherAETNA BEHAVORIAL HEALTH
IL363716771 0012OtherCIGNA BEHAVORIAL HEALTH
IL2232789OtherBCBS PROVIDER NUMBER
IL476392000OtherMAGELLAN HEALTH SERVICES
IL206554117OtherUNITED BEH. HEALTH PROVID
IL363716771 0012OtherCIGNA BEHAVORIAL HEALTH