| Kathy Q. Jordan, Lcsw, Llc | |
|
1 W Sunbridge Dr Fayetteville AR 72703-1825 | |
| (479) 443-5575 | |
| (479) 443-9554 |
| Full Name | Kathy Q. Jordan, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1 W Sunbridge Dr, Fayetteville, Arkansas |
| Authorized Official Name and Position | Kathy Quarles Jordan (OWNER) |
| Authorized Official Contact | 4794435575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathy Q. Jordan, Lcsw, Llc 1 W Sunbridge Dr Fayetteville AR 72703-1825 Ph: (479) 443-5575 | Kathy Q. Jordan, Lcsw, Llc 1 W Sunbridge Dr Fayetteville AR 72703-1825 Ph: (479) 443-5575 |
| NPI Number | 1467734400 |
|---|---|
| Provider Enumeration Date | 09/15/2011 |
| Last Update Date | 09/15/2011 |
| Medicare PECOS PAC ID | 4789065343 |
|---|---|
| Medicare Enrollment ID | O20220714000761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467734400 | NPI | - | NPPES |
| 1881623197 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1573-C (Arkansas) | Primary |
| Provider Name | Kathy Q Jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881623197 PECOS PAC ID: 2365417789 Enrollment ID: I20040830000673 |
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