Provider Demographics
NPI:1558198184
Name:BABCOCK, JORDAN ALYSE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALYSE
Last Name:BABCOCK
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 1:13416 NE 6TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2805
Mailing Address - Country:US
Mailing Address - Phone:832-610-0267
Mailing Address - Fax:
Practice Address - Street 1:3200 NE 109TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7749
Practice Address - Country:US
Practice Address - Phone:360-695-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor