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NPI Code Detail

MEDICARE: JORDAN JUDD LBA

MEDICARE: JORDAN JUDD LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLBA0381MN

General Provider Information

NPI Number : 1851917421
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN JUDD LBA
Provider Business Mailing Address
First Line : 9201 OLD CEDAR AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2401
Country : US
Telephone Number : 952-854-1800
Fax Number :
Provider Business Practice Location Address
First Line : 9201 OLD CEDAR AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2401
Country : US
Telephone Number : 952-854-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2020
Last Update Date : 12/18/2024

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