Individual
MELODY JEAN JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 CHESTNUT ST, PHILLIPS, WI 54555-1313
(715) 629-9274
Mailing address
171 CHESTNUT ST, PHILLIPS, WI 54555-1313
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20093-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20093-130
SUBSTANCE ABUSE COUNSELOR IN TRAINING
WI
Enumeration date
11/16/2022
Last updated
11/16/2022
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