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NPI Code Detail

MEDICARE: MS. MELODY KAYE JORGENSON M.S.W., PLCSW

MEDICARE:  MS. MELODY KAYE JORGENSON  M.S.W., PLCSW
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
11041C0700XClinical Social Worker2005022702MO

General Provider Information

NPI Number : 1437130648
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELODY KAYE JORGENSON M.S.W., PLCSW
Provider Business Mailing Address
First Line : 4304 S BEARFIELD RD
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-9557
Country : US
Telephone Number : 573-874-8686
Fax Number : 573-874-8608
Provider Business Practice Location Address
First Line : 4304 S BEARFIELD RD
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-9557
Country : US
Telephone Number : 573-874-8686
Fax Number : 573-874-8608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 07/09/2007

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Directions to “ MS. MELODY KAYE JORGENSON M.S.W., PLCSW” Practice Location

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