Provider Demographics
NPI:1831080134
Name:JORDAN, RILEY GRACE
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:GRACE
Last Name:JORDAN
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 1:370 EATON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1308
Mailing Address - Country:US
Mailing Address - Phone:248-675-5037
Mailing Address - Fax:
Practice Address - Street 1:1107 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5457
Practice Address - Country:US
Practice Address - Phone:517-999-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician