Provider Demographics
NPI:1437044757
Name:JOURDAIN-TOLIVER, JAKAYLA DANASIA
Entity type:Individual
Prefix:
First Name:JAKAYLA
Middle Name:DANASIA
Last Name:JOURDAIN-TOLIVER
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 1:4732 N BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-2405
Mailing Address - Country:US
Mailing Address - Phone:317-590-2763
Mailing Address - Fax:
Practice Address - Street 1:4732 N BOLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-2405
Practice Address - Country:US
Practice Address - Phone:317-590-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-382969106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician