Provider Demographics
NPI:1992568570
Name:COUGHLEN, JORDAN ALAN
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:ALAN
Last Name:COUGHLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 HEBERTON DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-3325
Mailing Address - Country:US
Mailing Address - Phone:949-923-0595
Mailing Address - Fax:
Practice Address - Street 1:5932 HEBERTON DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3325
Practice Address - Country:US
Practice Address - Phone:949-923-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical