Provider Demographics
NPI:1285113811
Name:TEIGE, JORDAN C (MS, LCPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:C
Last Name:TEIGE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 DAYBREAK DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-6700
Mailing Address - Country:US
Mailing Address - Phone:630-890-9644
Mailing Address - Fax:
Practice Address - Street 1:2256 DAYBREAK DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-6700
Practice Address - Country:US
Practice Address - Phone:630-890-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional