Provider Demographics
NPI:1386929669
Name:JORDAN, LINDSAY (LCSW, LISW)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-0029
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:
Practice Address - Street 1:1010 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1335
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077511041C0700X
OHI.12007271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical