Individual
JORDAN HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1123 GRAND AVE STE 103, SAINT PAUL, MN 55105-2629
(612) 500-1269
Mailing address
1123 GRAND AVE STE 103, SAINT PAUL, MN 55105-2629
(612) 500-1269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303530
MN
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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