Provider Demographics
NPI:1285986711
Name:WOOLMAN, JORDAN (LISW)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:WOOLMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSW, LISW
Mailing Address - Street 1:1527 DE WOLF ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2721
Mailing Address - Country:US
Mailing Address - Phone:515-971-4497
Mailing Address - Fax:
Practice Address - Street 1:1680 SW ANKENY RD STE 1A
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8270
Practice Address - Country:US
Practice Address - Phone:515-344-4126
Practice Address - Fax:515-219-4582
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA911AA9974101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor