KELLY JORDAN (NPI# 1356826325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356826325 |
| Entity Type | Individual |
| Full Name | KELLY JORDAN |
| Credential | PHD |
| Practice Address |
516 Mission House Ln New Brighton MN 55112-2571 |
| Mailing Address |
1993 Wellesley Ave Saint Paul MN 55105-1619 |
| Practice Telephone | 6516365120 |
| Mailing Telephone | 6127707858 |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TH0100X |
Psychologist Specialization: Health Service |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295178572 | Kelly E Jordan | Recreation Therapist | 21800 Celestial Cir, Pinckney, MI 48169-8765 | 2013-04-17 |
| 1124576426 | Kelly Jordan | Counselor | 51 Marina Blvd, Pittsburg, CA 94565-2068 | 2016-09-14 |
| 1083060396 | Kelly Jordan | Student in an Organized Health Care Education/Training Program | 747 52nd St, Oakland, CA 94609-1809 | 2016-05-05 |
| 1023377819 | Kelly Jean Jordan | Dental Hygienist | 2300 Lancaster Dr Ne, Salem, OR 97305-1223 | 2012-05-14 |
| 1669647020 | Kelly Jordan | Counselor | 420 Kellogg Ave, Ames, IA 50010-6226 | 2008-04-28 |
| 1467624809 | Kelly M Jordan | Physician Assistant | 4949 Harlem Rd, Amherst, NY 14226-2500 | 2008-03-26 |
| 1952501819 | Kelly E Jordan | Physical Therapist | 1610 Center St, Mobile, AL 36604-1512 | 2007-07-19 |
| Street Address |
516 MISSION HOUSE LN |
| City | NEW BRIGHTON |
| State | MN |
| Zip Code | 55112-2571 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164711735 | North Central Ministry Development Center, Inc. | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-04-04 |
| 1417558321 | Daniel Elenz | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2020-11-06 |
| 1124408570 | Marina Rosenthal | Counselor | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2015-06-01 |
| 1801161641 | Caroline A Burke | Specialist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2012-03-13 |
| 1447521356 | Shane Raymond Long | Marriage & Family Therapist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2012-01-24 |
| 1033401542 | Mary Lou Honstead | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-05-03 |
| 1710278502 | Mark Elmer Sundby | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1245781608 | Evan Fredrick Lieberman | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2016-10-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 103TH0100X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health Service |
| A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |
| Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164070942 | Jeremy Allen Strange | Psychologist | 965 Jefferson St Se Apt 1, Hutchinson, MN 55350-3249 | 2019-08-26 |
| 1235521857 | Abdikafi Sheikh | Psychologist | 419 Cedar Ave S # 379, Minneapolis, MN 55454-1032 | 2015-02-19 |
| 1093874281 | Thomas Leo Diana | Psychologist | 66 E 3rd St, Winona, MN 55987-3478 | 2006-12-06 |
| 1518485168 | Emily Anne Schmidtman | Psychologist | 4801 Veterans Drive, St. Cloud, MN 56329 | 2017-09-05 |
| 1184707002 | William N Robiner | Psychologist | 516 Delaware St Se, Pwb Third Floor, Clinic 3a, Minneapolis, MN 55455-0356 | 2006-10-23 |
| 1407864515 | Suzanne Beth Candell | Psychologist | 2550 University Ave W, Suite 189s, Saint Paul, MN 55114-1052 | 2006-08-04 |
| 1831132778 | Judith Blair Henderson | Psychologist | 5101 Olson Memorial Hwy, Suite 4002, Golden Valley, MN 55422-5149 | 2006-06-14 |
| City | NEW BRIGHTON |
| Zip Code | 55112 |
Please comment or provide details below to improve the information on KELLY JORDAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.