Provider Demographics
NPI:1629938410
Name:CARLSON, JORDAN ANN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANN
Last Name:CARLSON
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 1:9531 W 78TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3863
Mailing Address - Country:US
Mailing Address - Phone:612-399-6020
Mailing Address - Fax:952-214-7490
Practice Address - Street 1:9531 W 78TH ST STE 220
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3863
Practice Address - Country:US
Practice Address - Phone:612-399-6020
Practice Address - Fax:952-214-7490
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN283801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical