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General NPI Number Information
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NPI Number | 1295750248
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE JORGUSON M.ED
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 950 BROADWAY STE 404
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City | TACOMA
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State | WA
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Zip | 98402-4454
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Country | US
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Telephone | 206-774-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 16701 WALLER RD E
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City | TACOMA
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State | WA
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Zip | 98446-1337
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Country | US
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Telephone | 253-370-2062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61525524
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG61111490
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License Number State | WA
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