Provider Demographics
NPI:1225766074
Name:BJORGE, JOLENE S (LMSW)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:S
Last Name:BJORGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 S SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8302
Mailing Address - Country:US
Mailing Address - Phone:989-430-2735
Mailing Address - Fax:
Practice Address - Street 1:1670 S SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8302
Practice Address - Country:US
Practice Address - Phone:989-430-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
MI68010876071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty