Provider Demographics
NPI:1972199404
Name:HONSEY-GRETZ, JORDAN
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:HONSEY-GRETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3585
Mailing Address - Country:US
Mailing Address - Phone:507-200-2624
Mailing Address - Fax:
Practice Address - Street 1:201 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3585
Practice Address - Country:US
Practice Address - Phone:507-200-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)