Healthcare Provider Details

I. General information

NPI: 1760916423
Provider Name (Legal Business Name): MICHELLE E JORGENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICAH JORGENSON

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

IV. Provider business mailing address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW134577
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW134577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: