Individual
JON C NORDGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4400 W 69TH ST, SIOUX FALLS, SD 57108-8170
(605) 322-4004
(605) 322-4060
Mailing address
4400 W 69TH ST, SIOUX FALLS, SD 57108-8170
(605) 322-4004
(605) 322-4060
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
340
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025015700
—
NE
01
—
4995998
SD BLUECROSS PROV#
SD
05
—
557412900
—
MN
05
—
6551372
—
SC
01
—
9225136
DAKOTACARE
—
Enumeration date
01/05/2007
Last updated
11/11/2011
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