Provider Demographics
NPI:1861741290
Name:WOODSON, JORDAN G (NCTMB 440000-00)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:G
Last Name:WOODSON
Suffix:
Gender:F
Credentials:NCTMB 440000-00
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:G
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCTMB 440000-00
Mailing Address - Street 1:6917 W 76TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3077
Mailing Address - Country:US
Mailing Address - Phone:913-362-4800
Mailing Address - Fax:
Practice Address - Street 1:6917 W 76TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3077
Practice Address - Country:US
Practice Address - Phone:913-362-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist