Provider Demographics
NPI:1376356394
Name:JORGENSON, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:ND
Mailing Address - Zip Code:58561-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 BROADWAY
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:ND
Practice Address - Zip Code:58561-7010
Practice Address - Country:US
Practice Address - Phone:701-754-2971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist