Individual
MRS. KYLAN BROOK JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
2519 COVE AVE, LA GRANDE, OR 97850-3910
(541) 962-0830
Mailing address
88 RAPID RUN LOOP, LA GRANDE, OR 97850-1847
(541) 963-0233
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-1000722
OR
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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