MEDICARE: KIMBERLY ANNE JORGUSON M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MC61525524	WA
2	101YM0800X	Mental Health Counselor	CG61111490	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	164303	OTHER	WA	DEPT OF LABOR & INDUSTRIE
2	8933044	OTHER	WA	CRIME VICTIMS
3	4472JO	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1295750248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE JORGUSON M.ED

Provider Business Mailing Address
First Line	:	16701 WALLER RD E
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98446-1337
Country	:	US
Telephone Number	:	253-370-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 BROADWAY STE 404
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-4454
Country	:	US
Telephone Number	:	206-774-8557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/21/2024

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