Healthcare Provider Details

I. General information

NPI: 1427039692
Provider Name (Legal Business Name): JORDAN HART, PH.D., L.P., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W 35TH ST
MINNEAPOLIS MN
55408-4602
US

IV. Provider business mailing address

615 W 35TH ST
MINNEAPOLIS MN
55408-4602
US

V. Phone/Fax

Practice location:
  • Phone: 612-414-3540
  • Fax: 612-823-8438
Mailing address:
  • Phone: 612-414-3540
  • Fax: 612-823-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLP 4313
License Number StateMN

VIII. Authorized Official

Name: DR. JORDAN LYNN HART
Title or Position: PSYCHOLOGIST
Credential: PH.D., L.P.
Phone: 612-414-3540