Provider Demographics
NPI:1073036323
Name:JENSEN, BETHANY D (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:D
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DOWN EAST LN
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9047
Mailing Address - Country:US
Mailing Address - Phone:207-289-6270
Mailing Address - Fax:
Practice Address - Street 1:16 DOWN EAST LN
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9047
Practice Address - Country:US
Practice Address - Phone:207-289-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015021-1235Z00000X
MESP2638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist