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General NPI Number Information
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NPI Number | 1750605135
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Entity Type | Individual
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Provider Name | MRS. REBECCA LYNN JORGENSEN
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Gender | Female
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 424 CHURCH ST STE 2000
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City | NASHVILLE
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State | TN
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Zip | 37219-3304
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Country | US
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Telephone | 863-397-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 570 S ROSEWOOD DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-2385
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Country | US
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Telephone | 863-397-6652
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-07-3458
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1132
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License Number State | TN
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