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Individual

DR. JORDAN LYNN HART

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D., L.P.

Contact information

Practice address
5353 GAMBLE DR, SUITE 110, ST LOUIS PARK, MN 55416-1509
(763) 432-4071
(763) 432-4073
Mailing address
5353 GAMBLE DR, SUITE 110, ST LOUIS PARK, MN 55416-1509
(763) 432-4071
(763) 432-4073

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP 4313
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
108187
HEALTHPARTNERS HPFIN
MN
01
472437200
MN MEDICAL ASSISTANCE
MN
01
61-33379
MEDICA/UBH
MN
01
991N9HA
BCBS INDIVIDUAL PIN
MN
Enumeration date
11/07/2005
Last updated
01/25/2011
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