Active NPI
Phoebe Jordan, PHD
- Clinical Child & Adolescent Psychologist
- Ann Arbor, MI
National Provider Identifier
1770141194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 6301019280
- Practice address
- 1500 E Medical Center Dr
Ann Arbor, MI 48109-5000 - Phone
- (734) 936-4000
- NPI assigned
- May 31, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | P.08192 | OH | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6301019280 | MI | Primary |
Addresses
Primary practice location
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Mailing address
3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299
Other practice location 1
3333 Burnet Ave ML 3015
Cincinnati, OH 45229-3026
Phone (513) 636-4336
Other practice location 2
444 S 44th St
Omaha, NE 68131-3727
Phone (402) 559-6408
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301019280 | MI | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697587200000",
"number": "1770141194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081633",
"telephone_number": "734-647-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E MEDICAL CENTER DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481095000",
"telephone_number": "734-936-4000"
}
],
"practiceLocations": [
{
"address_1": "3333 Burnet Ave ML 3015",
"address_purpose": "LOCATION",
"city": "Cincinnati",
"state": "OH",
"postal_code": "452293026",
"country_code": "US",
"telephone_number": "513-636-4336",
"fax_number": "513-636-7756",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "444 S 44th St",
"address_purpose": "LOCATION",
"city": "Omaha",
"state": "NE",
"postal_code": "681313727",
"country_code": "US",
"telephone_number": "402-559-6408",
"fax_number": "402-559-5737",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JORDAN",
"first_name": "PHOEBE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-31",
"last_updated": "2023-10-18",
"certification_date": "2023-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OH",
"license": "P.08192",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "6301019280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.