Provider Demographics
NPI:1053145789
Name:ANSEL, JORDYN A (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:A
Last Name:ANSEL
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S L ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6945
Mailing Address - Country:US
Mailing Address - Phone:765-973-3488
Mailing Address - Fax:
Practice Address - Street 1:300 HUB ETCHISON PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5339
Practice Address - Country:US
Practice Address - Phone:765-973-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000012473103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool