Provider Demographics
NPI:1811370653
Name:HAZZARD, JORDAN WILLIAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:WILLIAM
Last Name:HAZZARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:WILLIAM
Other - Last Name:HAZZARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR HAZZARD
Mailing Address - Street 1:5297 COLLEGE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1797
Mailing Address - Country:US
Mailing Address - Phone:415-390-6725
Mailing Address - Fax:
Practice Address - Street 1:5297 COLLEGE AVE STE 107
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1797
Practice Address - Country:US
Practice Address - Phone:415-390-6725
Practice Address - Fax:415-390-6923
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35403103TP0814X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis