Individual
DR. MARK JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2701 W 68TH STREET, CHICAGO, IL 60629
(708) 991-9002
(908) 991-9003
Mailing address
162 S NORMANDY, CHICAGO HEIGHTS, IL 60411
(630) 218-4369
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71005770
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS BLUE SHIE
BC/BS ILLINOIS
IL
Enumeration date
10/03/2006
Last updated
07/08/2007
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