Provider Demographics
NPI:1063692093
Name:JORDAN, MARY PATRICIA (BS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BS
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Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE
Mailing Address - Street 2:SUITE C CARE OF CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:5301 TIETON DRIVE
Practice Address - Street 2:SUITE C CATHOLIC FAMILY & CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARC00014813101YM0800X
SA 60144432104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health