Provider Demographics
NPI:1427443464
Name:JORDAN, JASMINE DIANE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DIANE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N WASHINGTON ST
Mailing Address - Street 2:204
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2403
Mailing Address - Country:US
Mailing Address - Phone:509-389-2438
Mailing Address - Fax:
Practice Address - Street 1:9631 N NEVADA ST STE 209
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1197
Practice Address - Country:US
Practice Address - Phone:509-389-2438
Practice Address - Fax:509-593-4676
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC603029421041C0700X
WALW606054101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC 60302942OtherLICSW-A