Provider Demographics
NPI:1487266672
Name:JORDAN, ANNE MARIE LYNNE (MED, BCBA)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:LYNNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:469-573-4492
Mailing Address - Fax:866-430-1157
Practice Address - Street 1:11551 FOREST CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3920
Practice Address - Country:US
Practice Address - Phone:469-573-4492
Practice Address - Fax:866-430-1157
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3479103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst