Provider Demographics
NPI:1366319915
Name:JORDAN, ANIYA NICHOLE
Entity type:Individual
Prefix:
First Name:ANIYA
Middle Name:NICHOLE
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 1:1777 W STONES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7899
Mailing Address - Country:US
Mailing Address - Phone:317-438-2990
Mailing Address - Fax:317-960-4047
Practice Address - Street 1:1777 W STONES CROSSING RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7899
Practice Address - Country:US
Practice Address - Phone:317-438-2990
Practice Address - Fax:317-960-4047
Is Sole Proprietor?:No
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician