Individual
STELLA L JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 S. PECAN, BOLEY, OK 74829
(918) 667-3317
Mailing address
PO BOX 6, BOLEY, OK 74829-0006
(405) 567-0054
(405) 567-0055
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200125800A
—
OK
Enumeration date
12/15/2008
Last updated
12/15/2008
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