Active NPI
Jordan Lynn Hart, PH.D., L.P.
- Clinical Child & Adolescent Psychologist
- St Louis Park, MN
National Provider Identifier
1376524538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- LP 4313
- Practice address
- 5353 Gamble Dr
Suite 110
St Louis Park, MN 55416-1509 - Phone
- (763) 432-4071
- Fax
- (763) 432-4073
- NPI assigned
- Nov 7, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | LP 4313 | MN | Primary |
Addresses
Primary practice location
5353 Gamble Dr
Suite 110
St Louis Park, MN 55416-1509
Mailing address
5353 Gamble Dr
Suite 110
St Louis Park, MN 55416-1509
Phone (763) 432-4071
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 472437200 | Other | MN | MN MEDICAL ASSISTANCE |
| 61-33379 | Other | MN | MEDICA/UBH |
| 991N9HA | Other | MN | BCBS INDIVIDUAL PIN |
| 108187 | Other | MN | HEALTHPARTNERS HPFIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 4313 | MN | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1376524538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5353 GAMBLE DR",
"address_2": "SUITE 110",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161509",
"telephone_number": "763-432-4071",
"fax_number": "763-432-4073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 GAMBLE DR",
"address_2": "SUITE 110",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161509",
"telephone_number": "763-432-4071",
"fax_number": "763-432-4073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HART",
"first_name": "JORDAN",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D., L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-07",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MN",
"license": "LP 4313",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN MEDICAL ASSISTANCE",
"identifier": "472437200",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA/UBH",
"identifier": "61-33379",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVIDUAL PIN",
"identifier": "991N9HA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS HPFIN",
"identifier": "108187",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.