Provider Demographics
NPI:1871468025
Name:JORGENSON, JOEL ROBERT
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBERT
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 NW LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1085
Mailing Address - Country:US
Mailing Address - Phone:712-209-0788
Mailing Address - Fax:
Practice Address - Street 1:4720 MORTENSEN RD STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-5534
Practice Address - Country:US
Practice Address - Phone:515-599-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health