Provider Demographics
NPI:1013565241
Name:JENSEN, LINDSEY M (LSCW)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:M
Other - Last Name:HATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:400 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2028
Mailing Address - Country:US
Mailing Address - Phone:618-498-8552
Mailing Address - Fax:618-498-8439
Practice Address - Street 1:220 E COUNTY RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-3125
Practice Address - Country:US
Practice Address - Phone:618-498-8467
Practice Address - Fax:618-639-2017
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490212891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149021289OtherIDPR