Provider Demographics
NPI:1053441139
Name:JENSEN, NANCY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
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 1:2025 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6063
Mailing Address - Country:US
Mailing Address - Phone:847-612-0598
Mailing Address - Fax:847-559-0651
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:SUITE 416
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4508
Practice Address - Country:US
Practice Address - Phone:847-612-0598
Practice Address - Fax:847-559-0651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636034OtherBCBSIL
IL0001636034OtherBCBSIL