Provider Demographics
NPI:1124687843
Name:CHANDLER, JORDYN
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:CHANDLER
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 1:872C WALKER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2727
Mailing Address - Country:US
Mailing Address - Phone:302-285-9863
Mailing Address - Fax:
Practice Address - Street 1:872C WALKER RD STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2727
Practice Address - Country:US
Practice Address - Phone:302-285-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health