Provider Demographics
NPI:1366969453
Name:JORGENSEN, KIRSTEN DELAINEY
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:DELAINEY
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 FARNAM ST STE 509
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2879
Mailing Address - Country:US
Mailing Address - Phone:402-551-7338
Mailing Address - Fax:
Practice Address - Street 1:4239 FARNAM ST STE 509
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2879
Practice Address - Country:US
Practice Address - Phone:402-551-7338
Practice Address - Fax:402-551-3072
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE578235Z00000X
IA088623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist