Basic Information
| Provider Information | |||||||||
| NPI: | 1568102291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURDY | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2067 NORWICH CT | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479225957 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2104 GREENBRIAR DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760928355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174429022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2022 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-16-15039 | TX | Y |
No ID Information.