Basic Information
| Provider Information | |||||||||
| NPI: | 1174976328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORGENSEN | ||||||||
| FirstName: | EMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 COUNTY ROAD DF | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530399512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203864094 | ||||||||
| FaxNumber: | 9203863812 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 COUNTY ROAD DF | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530399512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203863807 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 16318 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 128617 | WI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 9340 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.