Provider Demographics
NPI:1861984650
Name:STAMPS, JORDAN ALEXIS
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXIS
Last Name:STAMPS
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 1:13618 BEHRENS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3579
Mailing Address - Country:US
Mailing Address - Phone:310-867-0671
Mailing Address - Fax:
Practice Address - Street 1:12440 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3177
Practice Address - Country:US
Practice Address - Phone:310-867-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW89234101YM0800X
89234104100000X
1041C0700X, 390200000X
CA1110861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DLU7908162DOtherANTHEM BLUE CROSS