Provider Demographics
NPI:1598895195
Name:JORGENSEN, KATHRYN RAWLS (MA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RAWLS
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:RAWLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:6460 N CAMINO ABBEY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2004
Mailing Address - Country:US
Mailing Address - Phone:520-742-5182
Mailing Address - Fax:
Practice Address - Street 1:1200 W. SPEEDWAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85754
Practice Address - Country:US
Practice Address - Phone:520-770-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10908101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ823519OtherAHCCS PIN#