MEDICARE: MISS DONNA L JORGENSEN

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	101Y00000X	Counselor	ISW 2346	FL

General Provider Information

NPI Number	:	1487782793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DONNA L JORGENSEN

Provider Business Mailing Address
First Line	:	1832 MY PLACE LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4571
Country	:	US
Telephone Number	:	561-312-0762
Fax Number	:	561-697-3143

Provider Business Practice Location Address
First Line	:	1832 MY PLACE LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4571
Country	:	US
Telephone Number	:	561-312-0762
Fax Number	:	561-697-3143

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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