| NPI | 1629548631 |
|---|---|
| Former Name | JORDAN DANIELLE BRECKENRIDGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.020747) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2024035058) |
| 104100000X Social Worker | |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2024-10-18 |