Provider Demographics
NPI:1659431153
Name:JORGENSEN, GERALD THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:THOMAS
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MOUNT LORETTA AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7826
Mailing Address - Country:US
Mailing Address - Phone:563-556-2580
Mailing Address - Fax:563-556-5464
Practice Address - Street 1:1229 MOUNT LORETTA AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7826
Practice Address - Country:US
Practice Address - Phone:563-556-2580
Practice Address - Fax:563-556-5464
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00028103TB0200X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling