Individual
JESSE JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1700 30TH AVE APT 1, MONROE, WI 53566-3161
(920) 609-8530
Mailing address
1700 30TH AVE APT 1, MONROE, WI 53566-3161
(920) 609-8530
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096003778
IL
2255A2300X
Athletic Trainer
Primary
1599-39
WI
Other
Enumeration date
07/14/2014
Last updated
07/22/2014
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