Provider Demographics
NPI:1912576109
Name:JORGENSEN, KRISTIN LEIGH (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4014 GRAND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1537
Mailing Address - Country:US
Mailing Address - Phone:608-332-5230
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S STE 503
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2336
Practice Address - Country:US
Practice Address - Phone:952-426-3034
Practice Address - Fax:612-807-1773
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN283691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical