Active NPI
Jaclyn Jorgensen
- Professional Counselor
- Traverse City, MI
National Provider Identifier
1386024511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401011728
- Practice address
- 1105 Sixth St
Traverse City, MI 49684-2349 - Phone
- (231) 935-6210
- NPI assigned
- Jun 3, 2015
- Last updated
- Apr 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401011728 | MI | Primary |
Addresses
Primary practice location
1105 Sixth St
Traverse City, MI 49684-2349
Mailing address
2513 Momentum PL
Chicago, IL 60689-5325
Phone (231) 935-6210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401011728 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461110400000",
"number": "1386024511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2513 MOMENTUM PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606895325",
"telephone_number": "231-935-6210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842349",
"telephone_number": "231-935-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "JACLYN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-03",
"last_updated": "2016-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401011728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.