Healthcare Provider Details

I. General information

NPI: 1568815959
Provider Name (Legal Business Name): JORDYN ANN KOSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDYN KONZE

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 9TH AVE S
FARGO ND
58103-2350
US

IV. Provider business mailing address

5147 44TH ST S
FARGO ND
58104-6069
US

V. Phone/Fax

Practice location:
  • Phone: 701-298-4500
  • Fax: 701-298-4400
Mailing address:
  • Phone: 701-369-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5017
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24379
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4262
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: