Individual
JORDAN SAGE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S AVENUE K, STATION 13, PORTALES, NM 88130-7400
(575) 562-1011
Mailing address
1500 S AVENUE K, STATION 13, PORTALES, NM 88130-7400
(575) 562-1011
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
01/27/2026
Last updated
01/27/2026
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