Provider Demographics
NPI:1083498166
Name:JIL W. JENSEN
Entity Type:Organization
Organization Name:JIL W. JENSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JIL
Authorized Official - Middle Name:WHITTLE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-475-0143
Mailing Address - Street 1:14890 LEGACY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-0045
Mailing Address - Country:US
Mailing Address - Phone:240-475-0143
Mailing Address - Fax:
Practice Address - Street 1:14890 LEGACY OAKS DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-0045
Practice Address - Country:US
Practice Address - Phone:240-475-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty