Individual
JORDAN MARRIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1353 E MAIN ST, BROWNSBURG, IN 46112-1433
(317) 520-4748
Mailing address
1431 HUNTERS GLN, ZIONSVILLE, IN 46077-3804
(770) 709-8598
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-47659
GA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AJS963W16619
ANTHEM
IN
Enumeration date
02/03/2021
Last updated
06/26/2023
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