Individual
JORDAN CHINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2793 LINEVILLE RD, GREEN BAY, WI 54313-7152
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5832-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054065
—
WI
Enumeration date
02/01/2016
Last updated
02/25/2025
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