Provider Demographics
NPI:1699323733
Name:MADDEN, JORDAN JOHN (DNP, CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JOHN
Last Name:MADDEN
Suffix:
Gender:
Credentials:DNP, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 GLASGOW ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-0010
Mailing Address - Country:US
Mailing Address - Phone:715-222-9032
Mailing Address - Fax:
Practice Address - Street 1:1810 CREST VIEW DR STE 6A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9317
Practice Address - Country:US
Practice Address - Phone:715-222-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2465330163W00000X
WI256951-30163W00000X
WI13870-33363LP0808X
MN9354363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse