Individual
KATHY QUARLES JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12 W. SUNBRIDGE, FAYETTEVILLE, AR 72703
(479) 750-2020
(479) 750-8967
Mailing address
P.O. BOX 6430, SPRINGDALE, AR 72766
(479) 750-2020
(479) 750-8967
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1573-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y996
BLUE SHIELD PROVIDER #
AR
Enumeration date
06/30/2006
Last updated
05/31/2011
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