Provider Demographics
NPI:1376042390
Name:JORGENSEN, WENDI M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:M
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44870 OH-7
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:OH
Mailing Address - Zip Code:45767
Mailing Address - Country:US
Mailing Address - Phone:703-627-1737
Mailing Address - Fax:
Practice Address - Street 1:44870 OH-7
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:OH
Practice Address - Zip Code:45767
Practice Address - Country:US
Practice Address - Phone:740-865-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11829235Z00000X
WALL60793488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist