| Doctor Name: | DR. MICHAEL LUTHER JORN |
| NPI Number: | 1073568697 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 1912 |
| Business Practice Address: | 4447 N Oakland Ave Shorewood, WI - 53211 |
| Business Phone Number: | 4144314322 |
| Business Fax Number: | 4144314323 |
| Mailing Address: | 1110 N Old World 3rd St Ste 410, MILWAUKEE |
| State: | WI |
| Postal Code: | 532031121 |
| Phone Number: | 4144314322 |
| Fax Number: | 4144314323 |
| NPI Enumeration Date: | 05/23/2006 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1912 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |