Provider Demographics
NPI:1114712924
Name:CLAEYS, JORDAN CAMILLA
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CAMILLA
Last Name:CLAEYS
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 1:1535 W 15TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7608
Mailing Address - Country:US
Mailing Address - Phone:316-300-7878
Mailing Address - Fax:
Practice Address - Street 1:1535 W 15TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7608
Practice Address - Country:US
Practice Address - Phone:316-300-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program