Individual
KELLY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
516 MISSION HOUSE LN, NEW BRIGHTON, MN 55112-2571
(651) 636-5120
Mailing address
1993 WELLESLEY AVE, SAINT PAUL, MN 55105-1619
(612) 770-7858
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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