Individual provider Active NPI

Katie Jo Jorgenson, LAC, LMSW

  • Addiction (Substance Use Disorder) Counselor
  • Devils Lake, ND
National Provider Identifier
1912399262
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
1745 Issued in ND
Practice address
200 Highway 2 W
Devils Lake, ND 58301-3532
Phone
(701) 665-2200
Fax
(701) 665-2300
NPI assigned
Feb 24, 2015
Last updated
Oct 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 5970 ND
Addiction (Substance Use Disorder) Counselor 101YA0400X 1745 ND Primary

Addresses

Primary practice location

200 Highway 2 W
Devils Lake, ND 58301-3532

Mailing address

200 Highway 2 W
Devils Lake, ND 58301-3532
Phone (701) 665-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210126000244 TX Practitioner - Clinical Social Worker 6204240765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spirit Lake TribeGroup PAC ID 2466550801, 22 clinicians

Practice addresses (Care Compare)

3883 74TH Ave NE
Spirit Lake Health Center
Fort Totten, ND 58335-0309
Phone (701) 766-1600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Spirit Lake Tribe CurrentSince May 4, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1912399262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HIGHWAY 2 W",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013532",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HIGHWAY 2 W",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013532",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSON",
        "first_name": "KATIE",
        "middle_name": "JO",
        "credential": "LAC, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-24",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "5970",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Devils Lake, ND

Sources for this page

Verify at the official NPI Registry.