Provider Demographics
NPI:1215738406
Name:JORDAN, ANESSA
Entity type:Individual
Prefix:
First Name:ANESSA
Middle Name:
Last Name:JORDAN
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 1:2514 POMEROY RD SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6514
Mailing Address - Country:US
Mailing Address - Phone:240-990-9848
Mailing Address - Fax:
Practice Address - Street 1:2514 POMEROY RD SE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6514
Practice Address - Country:US
Practice Address - Phone:240-990-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC4516747171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator