Provider Demographics
NPI:1689179954
Name:JORDAN, NANCY LYNN (MA, LADC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 E POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3331
Mailing Address - Country:US
Mailing Address - Phone:651-255-8558
Mailing Address - Fax:651-458-5632
Practice Address - Street 1:8451 E POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3331
Practice Address - Country:US
Practice Address - Phone:651-255-8558
Practice Address - Fax:651-458-5632
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)