Provider Demographics
NPI:1902632375
Name:GARDNER, JORDYN NICOLE (CMSSW)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:NICOLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CMSSW
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:NICOLE
Other - Last Name:MOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11726 CURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1103
Mailing Address - Country:US
Mailing Address - Phone:248-633-4638
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5113
Practice Address - Country:US
Practice Address - Phone:248-276-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852093933171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator