Provider Demographics
NPI:1811774037
Name:BEACH, JORDAN NICOLE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:BEACH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34755 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-8526
Mailing Address - Country:US
Mailing Address - Phone:970-381-2869
Mailing Address - Fax:
Practice Address - Street 1:1500 N CLYBOURN AVE UNIT C105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2295
Practice Address - Country:US
Practice Address - Phone:312-242-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA.B.61477567106E00000X
WACBT.CB.61472697106S00000X
CO1-24-78117103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician