Individual
JORDAN NORTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 W 4TH ST, ADA, OK 74820-3411
(580) 257-2444
Mailing address
301 W 4TH ST, ADA, OK 74820-3411
(580) 257-2444
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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