Provider Demographics
NPI:1912630088
Name:JORDAN, OLIVIA S (RBT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:S
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 MACKENZIE DR APT 7
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1858
Mailing Address - Country:US
Mailing Address - Phone:412-770-8472
Mailing Address - Fax:
Practice Address - Street 1:103 E AUGLAIZE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1506
Practice Address - Country:US
Practice Address - Phone:419-738-3366
Practice Address - Fax:833-409-2205
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT22223631106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician