Healthcare Provider Details

I. General information

NPI: 1457367054
Provider Name (Legal Business Name): JAMES LESTER JORGENSON ED,D, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 JOHN ST 2ND FLOOR
NORTH AURORA IL
60542-1600
US

IV. Provider business mailing address

101 COBBLESTONE TRL
DEKALB IL
60115-5207
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-1669
  • Fax: 630-801-1675
Mailing address:
  • Phone: 815-748-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: