Provider Demographics
NPI:1073292462
Name:JENSEN, RACHEL E (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:E
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 1:1772 E BOSTON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6243
Mailing Address - Country:US
Mailing Address - Phone:480-621-7257
Mailing Address - Fax:480-584-5825
Practice Address - Street 1:6640 E BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4437
Practice Address - Country:US
Practice Address - Phone:480-621-7257
Practice Address - Fax:480-584-5825
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical