Provider Demographics
NPI:1861809162
Name:JORDON, EMILY OLIVIA ROSEBROUGH (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:EMILY OLIVIA
Middle Name:ROSEBROUGH
Last Name:JORDON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:OLIVIA
Other - Last Name:ROSEBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E. THIRD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:803-545-5734
Mailing Address - Fax:803-434-4596
Practice Address - Street 1:900 E. THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-3271
Practice Address - Fax:423-778-4233
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
TN0000000331170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS