Healthcare Provider Details

I. General information

NPI: 1942892435
Provider Name (Legal Business Name): JORDAN LYNN ALABASE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11671 FOUNTAINS DR N STE 200
MAPLE GROVE MN
55369-4784
US

IV. Provider business mailing address

11671 FOUNTAINS DR N STE 200
MAPLE GROVE MN
55369-4784
US

V. Phone/Fax

Practice location:
  • Phone: 612-223-8898
  • Fax:
Mailing address:
  • Phone: 612-223-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32321
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: