Provider Demographics
NPI:1831792159
Name:CRANDAL, JORDAN FERRARI (LSCSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:FERRARI
Last Name:CRANDAL
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:SHARMAINE
Other - Last Name:FERRARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12062 SGT QUINN CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79908-3250
Mailing Address - Country:US
Mailing Address - Phone:334-412-2048
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11642104100000X
KS061991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker