Provider Demographics
NPI:1215938410
Name:JANKORD, JOHN LAMONT (JOHN JANKORD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAMONT
Last Name:JANKORD
Suffix:
Gender:M
Credentials:JOHN JANKORD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:L
Other - Last Name:JANKORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5354 PARKDALE DR STE 375
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1612
Mailing Address - Country:US
Mailing Address - Phone:952-224-0399
Mailing Address - Fax:952-224-0396
Practice Address - Street 1:5354 PARKDALE DR STE 375
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1612
Practice Address - Country:US
Practice Address - Phone:952-224-0399
Practice Address - Fax:952-224-0396
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301574101YA0400X
MN00054101YP2500X
MN1044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN160708100Medicaid