Provider Demographics
NPI:1295938132
Name:JORDAN, RACHEL MARIE (MSW, QMHP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 W BLUE BLAZE TRL
Mailing Address - Street 2:LOT F9
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-6419
Mailing Address - Country:US
Mailing Address - Phone:618-925-4122
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:615-658-2611
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health