Mary K. Jordan, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

13949 Issued in MN

Practice address

500 S Maple St
Waconia, MN 55387-1752

Phone

(952) 442-2191

NPI assigned

Jul 7, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1083611701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 FISCHER DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553877501",
            "telephone_number": "952-442-2191",
            "fax_number": "952-442-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S MAPLE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871752",
            "telephone_number": "952-442-2191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MARY",
        "middle_name": "K.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "13949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Johnson, MSN CNM
• Valerie Elizabeth Johnson, M.D.
• Rachel Johnston, OTR/L
• Corri Jones, LPCC
• Victoria Lea Jones, PA
• Jenelle Victoria Jorenby, FNP, CNP
• Sophia Jung, PT, DPT, ATC
• Kathryn Macthalena Jurado, LMFT
• Anne Benolken Jutting, MD
• Katelin Murphy, LPC, Atr, LLC

• Social Worker in Waconia, MN
• Providers in Waconia, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.