Provider Demographics
NPI:1003037862
Name:JENSEN, SANDRA RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:RAYMOND
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 NORTH 780 EAST
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042
Mailing Address - Country:US
Mailing Address - Phone:801-796-8976
Mailing Address - Fax:
Practice Address - Street 1:373 NORTH 780 EAST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042
Practice Address - Country:US
Practice Address - Phone:801-796-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3085063902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist