Jordan Blaine | Louisville, KY • PECOS Search

Jordan Blaine

Social Worker

Behavioral Health & Social Service Providers

1100 E Market St, Louisville, KY 40206-1838

PECOS Enrollment

Based on the most recent information from CMS, provider Jordan Blaine does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1699585158
Provider Type
Individual
Full Name
Blaine, Jordan
Credential
LCSW

Gender
Male
Sole Proprietor
No
Enumeration Date
1/8/2025
Last Updated
2/5/2025

Contact Information

Practice Location

1100 E Market St, Louisville, KY 40206-1838

Unlisted Fax

Mailing Location

1100 E Market St, Louisville, KY 40206-1838

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 259813 Kentucky