IndividualActive
Jordan Lakes, MSOT
NPI 1962856104 · Community Health Worker · Indianapolis, IN
Provider details
- NPI number
- 1962856104
- Entity type
- Individual
- Primary specialty
- Community Health WorkerOther Service Providers
- Credential
- MSOT
- Sex
- Male
- Sole proprietor
- Yes
- License
- 31006064A (IN)
Specialties & taxonomies
Other Service Providers
Practice location
9190 Priority Way West Dr
Indianapolis, IN 46240-6426
Phone: (317) 805-4963
Approximate (ZIP-level) locationGet directions
Mailing address
9190 Priority Way West Dr
Indianapolis, IN 46240-6426
Registry dates
- Enumerated
- 2016-04-13
- Last updated
- 2016-04-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.