Individual
DONNA JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
815 57TH ST UNIT I, KENOSHA, WI 53140-4062
(262) 354-7159
Mailing address
5015 31ST ST, KENOSHA, WI 53144-7320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16217-132
WI
101YP2500X
Professional Counselor
Primary
705-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326416355
CCHP. BCBS, UNITED HEALTHCARE
WI
05
—
1326416355
—
WI
Enumeration date
09/08/2015
Last updated
01/14/2020
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