1457367054 NPI number — DR. JAMES LESTER JORGENSON ED,D, LCPC

Table of content: JOY O'NEAL M-F.A. (NPI 1659527422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457367054 NPI number — DR. JAMES LESTER JORGENSON ED,D, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORGENSON
Provider First Name:
JAMES
Provider Middle Name:
LESTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED,D, LCPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457367054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 COBBLESTONE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-748-7696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 JOHN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NORTH AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60542-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-801-1669
Provider Business Practice Location Address Fax Number:
630-801-1675
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004523040 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com