Individual
KELLY JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 COUNTRY CLUB PLAZA DR, SAINT CHARLES, MO 63303-3859
(636) 724-1127
Mailing address
3279 MACKLIND AVE, SAINT LOUIS, MO 63139-1531
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016030814
MO
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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