Provider Demographics
NPI:1891589610
Name:JORDAN, ANDREW J (SSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:
Credentials:SSW
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:J
Other - Last Name:FADDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12760 S PARK AVE UNIT 520
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3422
Mailing Address - Country:US
Mailing Address - Phone:801-407-0047
Mailing Address - Fax:888-400-9232
Practice Address - Street 1:12760 S PARK AVE UNIT 520
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-3422
Practice Address - Country:US
Practice Address - Phone:801-407-0047
Practice Address - Fax:888-400-9232
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12680519-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker