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General NPI Number Information
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NPI Number | 1427039692
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Entity Type | Organization
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Legal Business Name | JORDAN HART, PH.D., L.P., LLC
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 615 W 35TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4602
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Country | US
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Telephone | 612-414-3540
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Fax | 612-823-8438
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Provider Business Mailing Address
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Address Line | 615 W 35TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4602
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Country | US
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Telephone | 612-414-3540
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Fax | 612-823-8438
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JORDAN LYNN HART
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Credential | PH.D., L.P.
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Telephone | 612-414-3540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | LP 4313
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License Number State | MN
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