Jordan Nicole Thepsourinthone, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2304664 Issued in OH

Practice address

2121 Hughes Dr Ste 640
Toledo, OH 43606-5131

Phone

(419) 291-3960

NPI assigned

Aug 9, 2023

Last updated

Aug 9, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1568145308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 BRODYWOOD DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436154584",
            "telephone_number": "419-215-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 HUGHES DR STE 640",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436065131",
            "telephone_number": "419-291-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEPSOURINTHONE",
        "first_name": "JORDAN",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2304664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chad Thebeau, ARRT (R.T.) (MR)
• Madison Jane Theis
• Shellie Theiss
• Steven Theiss, P.A.
• Kylie Thelen
• Thera Med LLC.
• Therapeutic by Nature, LLC
• Therapy Essentials
• Therapy Room LLC (The Therapy Room LLC)
• Theresa M Nemeth OD Inc

• Clinical Social Worker in Toledo, OH
• Providers in Toledo, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.