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General NPI Number Information
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NPI Number | 1437576840
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Entity Type | Individual
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Provider Name | JORDAN ROBINSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 3209 W 76TH ST STE 207
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City | EDINA
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State | MN
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Zip | 55435-5246
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Country | US
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Telephone | 517-614-3697
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 BALSAM TRL E
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City | SAINT PAUL
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State | MN
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Zip | 55123-1706
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Country | US
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Telephone | 517-614-3697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | LP6051
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License Number State | MN
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