Individual
JOURDAN PAIGE THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 UNIVERSAL CITY PLZ, UNIVERSAL CITY, CA 91608-1002
(909) 246-7020
Mailing address
1275 E DATE ST APT 201, SAN BERNARDINO, CA 92404-4202
(909) 246-7020
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12385087
KAISER
—
Enumeration date
11/21/2022
Last updated
11/21/2022
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