Provider Demographics
NPI:1326883943
Name:WADDELL JORDAN, ZARA LAYLA
Entity type:Individual
Prefix:
First Name:ZARA
Middle Name:LAYLA
Last Name:WADDELL 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 1:1300 S UNIVERSITY AVE BLDG 1-0801D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2642
Mailing Address - Country:US
Mailing Address - Phone:248-979-7978
Mailing Address - Fax:
Practice Address - Street 1:3917 RESEARCH PARK DR # B-1A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2229
Practice Address - Country:US
Practice Address - Phone:734-794-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician