Provider Demographics
NPI:1174789937
Name:JORDAN, JUDY ANN (MS)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HAWKINS DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1016
Mailing Address - Country:US
Mailing Address - Phone:319-356-1323
Mailing Address - Fax:319-356-8284
Practice Address - Street 1:100 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1016
Practice Address - Country:US
Practice Address - Phone:319-353-6456
Practice Address - Fax:319-356-8284
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA170893222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist