Individual
COURTNEY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
(618) 566-0313
Mailing address
522 E MAIN ST, MASCOUTAH, IL 62258-2240
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-52055
IL
Other
Enumeration date
03/27/2018
Last updated
03/27/2018
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