Individual
JORDAN LANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
27 LAVENDER LN, PONDERAY, ID 83852-5107
(406) 465-2465
Mailing address
27 LAVENDER LN, PONDERAY, ID 83852-5107
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-48937
MT
Other
Enumeration date
05/17/2022
Last updated
05/17/2022
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