MEDICARE: MS. KATHY ANN JORGENSEN LMSW, ASW

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	1041C0700X	Clinical Social Worker	LMSW 4493	KS
2	104100000X	Social Worker	36776	CA

General Provider Information

NPI Number	:	1336324201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ANN JORGENSEN LMSW, ASW

Provider Business Mailing Address
First Line	:	1933 S BROADWAY
Second Line	:	STE 6
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1933 S BROADWAY
Second Line	:	STE 6
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4501
Country	:	US
Telephone Number	:	213-742-1400
Fax Number	:

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	03/14/2014

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