Individual
JORDAN ROBERT BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CT
Contact information
Practice address
5209 DETROIT AVENUE, CLEVELAND, OH 44102
(216) 651-2037
Mailing address
5209 DETROIT AVENUE, CLEVELAND, OH 44102
(216) 651-2037
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.2305565
OH
171M00000X
Case Manager/Care Coordinator
—
OH
172V00000X
Community Health Worker
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0459264
—
OH
Enumeration date
08/30/2021
Last updated
11/15/2023
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