Healthcare Provider Details

I. General information

NPI: 1396657789
Provider Name (Legal Business Name): JORDYN MARIE WOLFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 ARIEL ST N STE A
SAINT PAUL MN
55109-2202
US

IV. Provider business mailing address

7981 HINCKLEY RD APT 207
BAXTER MN
56425-1401
US

V. Phone/Fax

Practice location:
  • Phone: 651-773-0354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number107931
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: