Individual
MS. PHYLLIS LIZETTA JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHP
Contact information
Practice address
721 FAWCETT AVE STE 101721S, TACOMA, WA 98402-5502
(253) 207-4312
(253) 207-4318
Mailing address
721 FAWCETT AVE STE 101, TACOMA, WA 98402-5502
(253) 207-4312
(253) 207-4318
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JORDAPL361NU
DRIVER'S LICENSE
WA
Enumeration date
05/06/2020
Last updated
05/06/2020
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