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General NPI Number Information
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NPI Number | 1992346365
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Entity Type | Individual
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Provider Name | DANI L JORGENSON CADC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 401 W BRIDGE ST
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City | STREATOR
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State | IL
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Zip | 61364-2705
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Country | US
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Telephone | 815-220-0299
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Fax | 815-220-0583
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Provider Business Mailing Address
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Address Line | 401 W BRIDGE ST
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City | STREATOR
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State | IL
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Zip | 61364-2705
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Country | US
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Telephone | 815-220-0299
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Fax | 815-220-0583
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 32588
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License Number State | IL
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