Healthcare Provider Details

I. General information

NPI: 1275984668
Provider Name (Legal Business Name): RACHAEL ELIZABETH JORGENSEN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CLAY ST
CEDAR FALLS IA
50613-2971
US

IV. Provider business mailing address

604 CLAY ST
CEDAR FALLS IA
50613-2971
US

V. Phone/Fax

Practice location:
  • Phone: 319-415-6405
  • Fax:
Mailing address:
  • Phone: 319-415-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0007850
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007850
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0074435
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: