Provider Demographics
NPI:1083081624
Name:JENSEN, LINDA MARIE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 7TH ST
Mailing Address - Street 2:STE B10
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2759
Mailing Address - Country:US
Mailing Address - Phone:208-819-2716
Mailing Address - Fax:
Practice Address - Street 1:101 SKI RD
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2843
Practice Address - Country:US
Practice Address - Phone:406-293-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT123291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical