Provider Demographics
NPI:1508415134
Name:MANLEY, JORDAN CASEY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CASEY
Last Name:MANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:CM
Other - Last Name:AMUNDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 WISCONSIN STREET
Mailing Address - Street 2:BUILDING 2, SUITE 405B
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703
Mailing Address - Country:US
Mailing Address - Phone:715-598-9988
Mailing Address - Fax:
Practice Address - Street 1:800 WISCONSIN STREET
Practice Address - Street 2:BUILDING 2, SUITE 405B
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703
Practice Address - Country:US
Practice Address - Phone:715-598-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8401-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty