Provider Demographics
NPI:1558118422
Name:JORDAN, SARAH (QBHS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CENTRAL CTR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2253
Mailing Address - Country:US
Mailing Address - Phone:740-771-9022
Mailing Address - Fax:740-331-7555
Practice Address - Street 1:20 CENTRAL CTR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2253
Practice Address - Country:US
Practice Address - Phone:740-771-9022
Practice Address - Fax:740-331-7555
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker