Provider Demographics
NPI:1700226156
Name:JORGENSEN, JETTE BJORK (CMT NCTMB)
Entity Type:Individual
Prefix:
First Name:JETTE
Middle Name:BJORK
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:CMT NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 MADISON AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7467
Mailing Address - Country:US
Mailing Address - Phone:916-218-6125
Mailing Address - Fax:916-218-6086
Practice Address - Street 1:7509 MADISON AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7467
Practice Address - Country:US
Practice Address - Phone:916-218-6125
Practice Address - Fax:916-218-6086
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist