Provider Demographics
NPI:1124698824
Name:SELEMBA, JORDAN
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:SELEMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SCHMUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:769 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-1202
Mailing Address - Country:US
Mailing Address - Phone:570-855-0830
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKHILL SQ S
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1016
Practice Address - Country:US
Practice Address - Phone:570-802-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician