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NPI Code Detail

MEDICARE: ANNA JORGENSON

MEDICARE: ANNA JORGENSON
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C5V831757234OTHERMNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1700508330
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA JORGENSON
Provider Business Mailing Address
First Line : 12337 195TH AVE NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-4143
Country : US
Telephone Number : 763-238-8778
Fax Number :
Provider Business Practice Location Address
First Line : 3401 ROUND LAKE BLVD NW
Second Line :
City : ANOKA
State : MN
Zip : 55303-3315
Country : US
Telephone Number : 952-247-3581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2022
Last Update Date : 09/12/2022

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Directions to “ ANNA JORGENSON ” Practice Location

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