Jordan Michael Peterson Stephan, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

33011238A Issued in IN

Practice address

10016 Monticello Blvd
Fort Wayne, IN 46825-2193

Phone

(920) 379-5728

NPI assigned

Feb 26, 2024

Last updated

Feb 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1700642774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10016 MONTICELLO BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252193",
            "telephone_number": "920-379-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10016 MONTICELLO BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252193",
            "telephone_number": "920-379-5728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON STEPHAN",
        "first_name": "JORDAN",
        "middle_name": "MICHAEL",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "33011238A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Caroline Peters, PHARMD
• Jessica Marie Peters, M.H.S CCC-SLP
• Juliette Peters, RPH
• Margaret Peters, MS
• Dustin J Petersen, M.D.
• Wayne Peterson Stephan, LMHC
• Alan C Peterson, M.D.
• Casey Elizabeth Peterson, FNP
• Danielle M Peterson, LSW, MSSA
• Eric G Peterson, M.D.

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.