Provider Demographics
NPI:1093861379
Name:JORDAN, DANIELLE ALENE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ALENE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MERRIAM AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2334
Mailing Address - Country:US
Mailing Address - Phone:651-735-4841
Mailing Address - Fax:651-735-8470
Practice Address - Street 1:120 LABREE AVE S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2840
Practice Address - Country:US
Practice Address - Phone:218-683-4351
Practice Address - Fax:218-683-4362
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical