Individual
DR. GARY Q JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
501 CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 598-4187
(801) 523-0263
Mailing address
PO BOX 901535, SANDY, UT 84090-1535
(801) 598-4187
(801) 523-0263
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103687-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C0144
—
UT
Enumeration date
03/02/2007
Last updated
07/08/2007
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