Nordgren, Jon C

Nordgren, Jon C is an individual health care provider with primary practice located at 4400 W 69Th St , Sioux Falls SD 57108-8170. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Nordgren, Jon C can be contacted via phone (605) 322-4004.

Contact Information

Primary practice address
4400 W 69Th St Sioux Falls SD 57108-8170
Phone: (605) 322-4004
Fax: (605) 322-4060
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 340 South Dakota

Profile Details

NPI number 1619024049
LBN Legal business name Nordgren, Jon C
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 5th, 2007
Last updated Nov 11th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619024049 NPPES
Minnesota MEDICAID 557412900
Minnesota MEDICAID 6551372
Minnesota Other 4995998
Minnesota Other 9225136
Minnesota MEDICAID 10025015700

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