Provider Demographics
NPI:1053499061
Name:KUENNEN JORDAN, CLAIRE L (LICSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:L
Last Name:KUENNEN JORDAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:L
Other - Last Name:KUENNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:2595 COHANSEY ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3521
Mailing Address - Country:US
Mailing Address - Phone:651-484-6258
Mailing Address - Fax:
Practice Address - Street 1:1575 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1126
Practice Address - Country:US
Practice Address - Phone:651-232-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN065711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical