1083749766 NPI number — MS. HELEN F JURGENSEN LCSW MSW

Table of content: MS. HELEN F JURGENSEN LCSW MSW (NPI 1083749766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083749766 NPI number — MS. HELEN F JURGENSEN LCSW MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JURGENSEN
Provider First Name:
HELEN
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW MSW
Provider Gender Code:
F

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:
1083749766
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:
PO BOX 080196
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53208-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-476-1073
Provider Business Mailing Address Fax Number:
414-476-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5508 W VLIET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53208-8003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-476-1073
Provider Business Practice Location Address Fax Number:
414-476-0223
Provider Enumeration Date:
02/22/2007

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: 1041C0700X , with the licence number:  LCSW583123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 280196 . This is a "VALUE OPTIONS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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