Provider Demographics
NPI:1841162930
Name:JORDAHL, SYDNEY R
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:R
Last Name:JORDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E MILITARY AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5433
Mailing Address - Country:US
Mailing Address - Phone:531-666-0251
Mailing Address - Fax:402-552-4900
Practice Address - Street 1:928 S 188TH CT
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-5612
Practice Address - Country:US
Practice Address - Phone:531-666-0251
Practice Address - Fax:402-552-4900
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician