Individual
JORDYN VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4005 FELLAND RD STE 102, MADISON, WI 53718-6461
(920) 857-9041
Mailing address
1575 ALLOUEZ AVE, GREEN BAY, WI 54311-5639
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
486-140
WI
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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