Individual provider Active NPI

Mary Elizabeth Jordan, LISW, IADC

  • Clinical Social Worker
  • Sioux City, IA
National Provider Identifier
1063712040
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
007068 Issued in IA
Practice address
1551 Indian Hills Dr Ste 206
Sioux City, IA 51104-1857
Phone
(712) 258-4700
NPI assigned
Oct 25, 2010
Last updated
Oct 25, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 007068 IA Primary

Addresses

Primary practice location

1551 Indian Hills Dr Ste 206
Sioux City, IA 51104-1857

Mailing address

1551 Indian Hills Dr Ste 206
Sioux City, IA 51104-1857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
007068IAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287964800000",
    "number": "1063712040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 INDIAN HILLS DR STE 206",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 INDIAN HILLS DR STE 206",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041857",
            "telephone_number": "712-258-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LISW, IADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-25",
        "last_updated": "2010-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "007068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.