DANA PATRICK JERGENS Athletic Trainer License verification

Business Entity

NOT RENEWED

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096001972

License Status

NOT RENEWED

Business

First Name

DANA

Middle

PATRICK

Last Name

JERGENS

Business Name

DANA PATRICK JERGENS

Original Issue Date

08/31/2004

Effective Date

08/31/2004

Expiration Date

05/31/2006

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

07/17/2006