Provider Demographics
NPI:1215764808
Name:JORDAN, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JORDAN
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 1:7333 INTERNATIONAL PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8418
Mailing Address - Country:US
Mailing Address - Phone:941-907-3443
Mailing Address - Fax:941-527-0526
Practice Address - Street 1:4740 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9058
Practice Address - Country:US
Practice Address - Phone:941-907-3443
Practice Address - Fax:941-527-0526
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician