Individual
MAUDEEN GRACE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2004 MAIN ST, SUITE 203, FOREST GROVE, OR 97116-2349
(503) 998-6803
Mailing address
9335 SW BIRDIE DR, CORNELIUS, OR 97113-9621
(503) 998-6803
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 3139
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW 3139
LICENSE IN CLINICAL SOCIAL WORK
OR
Enumeration date
05/27/2008
Last updated
05/27/2008
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