Healthcare Provider Details

I. General information

NPI: 1871864835
Provider Name (Legal Business Name): JENNIFER JOY BJERKE PH.D., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17142 E EL PUEBLO BLVD
FOUNTAIN HILLS AZ
85268-2506
US

IV. Provider business mailing address

17142 E EL PUEBLO BLVD
FOUNTAIN HILLS AZ
85268-2506
US

V. Phone/Fax

Practice location:
  • Phone: 480-212-3991
  • Fax: 480-816-1701
Mailing address:
  • Phone: 480-212-3991
  • Fax: 480-816-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13051
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: