Basic Information
| Provider Information | |||||||||
| NPI: | 1750825030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACKERMAN | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 S SUNWEST LN | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083258 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 E GILBERT STREET | ||||||||
| Address2: | COTTAGE 4 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877000 | ||||||||
| FaxNumber: | 9093877611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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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 | 106H00000X | AMFT108302 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.