Jordan Lande, LCSW
Individual provider Active NPI Clinical Social Worker · Ponderay, ID
NPI 1346987625 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1346987625
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- BBH-LCSW-LIC-48937 (MT)
- Practice address
- 27 Lavender LN
Ponderay, ID 83852-5107 - Phone
- (406) 465-2465
- NPI assigned
- May 17, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BBH-LCSW-LIC-48937 | MT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | BBH-LCSW-LIC-48937 | MT | Yes |
Addresses
Primary practice location
27 Lavender LN
Ponderay, ID 83852-5107
Mailing address
27 Lavender LN
Ponderay, ID 83852-5107
Other providers in Ponderay, ID
- Knopp Anesthesia Services LLC
- Paul Erwin Koch
- Brittnie N Kohler
- Linsey Ladonna Kucherry
- Adam Kusler
- Elizabeth Larsen
- Anna Louise Lawrence
- Ryan Leisy
- Lincare Inc
- Alice Loraine
All providers in Ponderay, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.