Provider Demographics
NPI:1841074820
Name:JORDAN, SARAH NICOLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:JORDAN
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 1:104 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-1210
Mailing Address - Country:US
Mailing Address - Phone:417-476-1000
Mailing Address - Fax:417-476-1082
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723-1210
Practice Address - Country:US
Practice Address - Phone:417-476-1000
Practice Address - Fax:417-476-1082
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker