Organization
INTERPERSONNEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HOLLY JORGENSON LCSW (OWNER)
(608) 345-2273
Entity
Organization
Contact information
Practice address
401 WISCONSIN AVE, MADISON, WI 53703-1487
(608) 345-2273
(608) 256-5116
Mailing address
2205 COMMONWEALTH AVE, MADISON, WI 53726-5301
(608) 345-2273
(608) 256-5116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4026123
WI
101YP2500X
Professional Counselor
4026126
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659452571
—
WI
Enumeration date
05/15/2014
Last updated
05/15/2014
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