| Doctor Name: | DR. DANIELLE ALENE JORDAN |
| NPI Number: | 1093861379 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., L.P. |
| License Number: | LP4394 |
| Business Practice Address: | 120 Labree Ave S Thief River Falls, MN - 567012840 |
| Business Phone Number: | 2186834351 |
| Business Fax Number: | 2186834362 |
| Mailing Address: | 320 Merriam Ave N, THIEF RIVER FALLS |
| State: | MN |
| Postal Code: | 567012334 |
| Phone Number: | 6517354841 |
| Fax Number: | 6517358470 |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 05/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP4394 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |