Provider Demographics
NPI:1033263165
Name:JENSEN, CLAIGH H (MSW)
Entity Type:Individual
Prefix:MR
First Name:CLAIGH
Middle Name:H
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 JOHN ADAMS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4300
Mailing Address - Country:US
Mailing Address - Phone:208-529-5276
Mailing Address - Fax:208-529-6506
Practice Address - Street 1:1600 JOHN ADAMS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4300
Practice Address - Country:US
Practice Address - Phone:208-529-5276
Practice Address - Fax:208-529-6506
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-292731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11538493OtherCAQH