Individual
MASON W JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
859 S YELLOWSTONE HWY STE 202, REXBURG, ID 83440-5294
(307) 257-5487
Mailing address
PO BOX 20310 UNIT #55984, CHEYENNE, WY 82003-7007
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/03/2024
Last updated
05/03/2024
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