Basic Information
| Provider Information | |||||||||
| NPI: | 1023567740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | LISW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4822 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445122148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305448005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Practice Location | |||||||||
| Address1: | 4822 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445122148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305448005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2016 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1600786 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | I.1801107 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.