Individual
MARISA JEAN JERGENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, CADC
Contact information
Practice address
211 AVENUE M W, FORT DODGE, IA 50501-5789
(515) 576-7261
(515) 955-7628
Mailing address
211 AVENUE M W, FORT DODGE, IA 50501-5789
(515) 576-7261
(515) 955-7628
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21037
IA
163W00000X
Registered Nurse
Primary
131852
IA
Other
Enumeration date
03/24/2021
Last updated
06/19/2023
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