Provider Demographics
NPI:1154625853
Name:JORGENSEN, LUKE A
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 33RD ST
Mailing Address - Street 2:STE 8
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7632
Mailing Address - Country:US
Mailing Address - Phone:319-321-4303
Mailing Address - Fax:
Practice Address - Street 1:2230 33RD ST
Practice Address - Street 2:STE 8
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7632
Practice Address - Country:US
Practice Address - Phone:712-336-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1014237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist