Jordan Lewis Wiederstein, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

64300 Issued in TX

Practice address

1506 Bexar Crossing St
San Antonio, TX 78232-1587

Phone

(210) 208-5633

Fax

(210) 832-5005

NPI assigned

Jan 10, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jordan Lewis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• BCFS Health and Human Services

  • Case Management Agency
  • Laredo, TX
  • NPI 1689751596
  NPD (past)

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294617600000",
    "number": "1255635967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 BEXAR CROSSING ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321587",
            "telephone_number": "210-208-5633",
            "fax_number": "210-832-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 BEXAR CROSSING ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321587",
            "telephone_number": "210-208-5633",
            "fax_number": "210-832-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDERSTEIN",
        "first_name": "JORDAN",
        "middle_name": "LEWIS",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-10",
        "last_updated": "2011-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "64300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "LEWIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lawrence Edward Widman, M.D.
• Ian Wiechers
• Alexandra Wiechmann, O.D.
• Dean Michael Wieczorek, D.O.
• Michael Wieczorkowski, PA-C, ATC
• Kristopher Wieland
• Abrana Wielgosiak
• Marcy R Wiemers, M.D.
• Nicole Wienecke, OTR
• Sherman Wayne Wieneke, AGNP

• Counselor in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; 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.