Individual
ANDREW JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
8620 W EMERALD ST STE 150, BOISE, ID 83704-4839
(208) 617-3265
Mailing address
4148 W BRENDA LN, MERIDIAN, ID 83646-9038
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
ID
Other
Enumeration date
10/17/2025
Last updated
10/17/2025
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