Provider Demographics
NPI:1679209530
Name:HAWKINS, JORDAN MAKENIZE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MAKENIZE
Last Name:HAWKINS
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 1:6300 W OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2654
Mailing Address - Country:US
Mailing Address - Phone:612-509-6670
Mailing Address - Fax:
Practice Address - Street 1:6300 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-2654
Practice Address - Country:US
Practice Address - Phone:612-509-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician