Provider Demographics
NPI:1487661906
Name:JORGENSEN, KIM MCCANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MCCANN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2255
Mailing Address - Country:US
Mailing Address - Phone:608-231-3191
Mailing Address - Fax:608-231-3108
Practice Address - Street 1:2709 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2255
Practice Address - Country:US
Practice Address - Phone:608-231-3191
Practice Address - Fax:608-231-3108
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2454-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000784150Medicare ID - Type UnspecifiedAS A PSYCHOTHERAPIST