Provider Demographics
NPI:1689560088
Name:SCOTT-SPANN, JORDYN CASHMERE (BEHAVIORAL TECH)
Entity type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:CASHMERE
Last Name:SCOTT-SPANN
Suffix:
Gender:F
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:374 HILLSIDE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2775
Mailing Address - Country:US
Mailing Address - Phone:862-682-9990
Mailing Address - Fax:
Practice Address - Street 1:1050 GALLOPING HILL RD STE 205
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7980
Practice Address - Country:US
Practice Address - Phone:908-686-1505
Practice Address - Fax:908-428-4441
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician