Healthcare Provider Details

I. General information

NPI: 1437067766
Provider Name (Legal Business Name): KATHERINE JORGENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 STATE ST STE 600
SALEM OR
97301-3583
US

IV. Provider business mailing address

657 SE COOPER ST
DALLAS OR
97338-1945
US

V. Phone/Fax

Practice location:
  • Phone: 971-375-1523
  • Fax:
Mailing address:
  • Phone: 971-375-1523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10084
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: