Provider Demographics
NPI:1033123518
Name:JENSEN, DEBRA CYD (SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:CYD
Last Name:JENSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 COBBLESTONE LN
Mailing Address - Street 2:COURAGE BURNSVILLE
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4578
Mailing Address - Country:US
Mailing Address - Phone:952-898-5700
Mailing Address - Fax:952-898-5757
Practice Address - Street 1:100 COBBLESTONE LN
Practice Address - Street 2:COURAGE BURNSVILLE
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4578
Practice Address - Country:US
Practice Address - Phone:952-898-5700
Practice Address - Fax:952-898-5757
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP47754OtherHEALTH PARTNERS
MN106G6JEOtherBCBS
4600809OtherMEDICA