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General NPI Number Information
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NPI Number | 1538079629
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Entity Type | Individual
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Provider Name | JORDAN ELIZABETH THOMAS LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 1650 W END BLVD STE 100
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-5369
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Country | US
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Telephone | 763-331-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 2322 SILVER LN APT 309
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-7461
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28592
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License Number State | MN
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