Provider Demographics
NPI:1083288039
Name:TREUBER, JORDANAI ANNE
Entity Type:Individual
Prefix:MS
First Name:JORDANAI
Middle Name:ANNE
Last Name:TREUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1013
Mailing Address - Country:US
Mailing Address - Phone:763-482-9450
Mailing Address - Fax:
Practice Address - Street 1:1510 12TH ST N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1013
Practice Address - Country:US
Practice Address - Phone:763-482-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251V00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable