Healthcare Provider Details

I. General information

NPI: 1659607745
Provider Name (Legal Business Name): DEBORAH ANNE JORGENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6753 STATE RD
PARMA OH
44134-4517
US

IV. Provider business mailing address

PO BOX 72767
CLEVELAND OH
44192-0004
US

V. Phone/Fax

Practice location:
  • Phone: 216-391-2030
  • Fax: 440-843-5588
Mailing address:
  • Phone: 800-860-7373
  • Fax: 330-668-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162988
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1701367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: