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NPI Code Detail

MEDICARE: MR. DON A JORGENSEN LCSW

MEDICARE: MR. DON A JORGENSEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist2522-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417094038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DON A JORGENSEN LCSW
Provider Business Mailing Address
First Line : 1906 EAGLEWOOD DRIVE
Second Line :
City : VERONA
State : WI
Zip : 53593-7800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 515 22ND AVE
Second Line :
City : MONROE
State : WI
Zip : 53566-1569
Country : US
Telephone Number : 608-324-2770
Fax Number : 608-324-2469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 12/07/2025

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