Provider Demographics
NPI:1649879339
Name:BROWN, JORDAN (BS, LADC, MSW, LGSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BS, LADC, MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2749
Mailing Address - Country:US
Mailing Address - Phone:218-215-2573
Mailing Address - Fax:
Practice Address - Street 1:4615 GRAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2749
Practice Address - Country:US
Practice Address - Phone:218-215-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304516101YA0400X
MN29050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)