Active NPI
Kristine M. Jordan, LISW
- Clinical Social Worker
- Fairview Park, OH
National Provider Identifier
1609092006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I 0009562
- Practice address
- 20939 Lorain Rd
Suite 8
Fairview Park, OH 44126-2022 - Phone
- (440) 331-2010
- Fax
- (440) 331-2052
- NPI assigned
- Apr 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I 0009562 | OH | Primary |
Addresses
Primary practice location
20939 Lorain Rd
Suite 8
Fairview Park, OH 44126-2022
Mailing address
4807 Rockside Rd
Ste 610
Independence, OH 44131-2166
Phone (216) 906-1117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H146141 | Other | OH | MEDICARE PTAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I 0009562 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alternative Horizon Counseling | Current | Accepting new patients | |
| Cunningham & Jordan Counseling Associates | Clinical | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Social Worker
- Fairview Park, OH
- NPI 1669643268
-
- Addiction (Substance Use Disorder) Counselor
- Independence, OH
- NPI 1922654276
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1609092006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4807 ROCKSIDE RD",
"address_2": "STE 610",
"city": "INDEPENDENCE",
"state": "OH",
"postal_code": "441312166",
"telephone_number": "216-906-1117",
"fax_number": "330-835-9552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20939 LORAIN RD",
"address_2": "SUITE 8",
"city": "FAIRVIEW PARK",
"state": "OH",
"postal_code": "441262022",
"telephone_number": "440-331-2010",
"fax_number": "440-331-2052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "KRISTINE",
"middle_name": "M.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I 0009562",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "H146141",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairview Park, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.