Provider Demographics
NPI:1487440228
Name:HARGADON, JORDAN DENISE (OT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DENISE
Last Name:HARGADON
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:DENISE
Other - Last Name:HOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:340 TESCONI CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4676
Mailing Address - Country:US
Mailing Address - Phone:707-546-9160
Mailing Address - Fax:707-546-1338
Practice Address - Street 1:340 TESCONI CIR STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4676
Practice Address - Country:US
Practice Address - Phone:707-546-9160
Practice Address - Fax:707-546-1338
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22608OtherOT LICENSE