Provider Demographics
NPI:1184345118
Name:ROOT-JAPENGA, JORDAN (LMFT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ROOT-JAPENGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:ROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-0076
Mailing Address - Country:US
Mailing Address - Phone:515-297-4028
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 76
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-0076
Practice Address - Country:US
Practice Address - Phone:319-596-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113931106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist