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General NPI Number Information
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NPI Number | 1992302228
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Entity Type | Organization
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Legal Business Name | JSR NEUROPSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 12/20/2021
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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 | 3618 WOODCREST CIR
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City | EAGAN
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State | MN
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Zip | 55123-1363
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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 | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. JORDAN S ROBINSON
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Credential | PHD
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Telephone | 517-614-3697
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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 |
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License Number State |
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