Provider Demographics
NPI:1093081135
Name:JENSEN, KATHERINE E (MAED, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MAED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 ASH CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2154
Mailing Address - Country:US
Mailing Address - Phone:757-650-6658
Mailing Address - Fax:
Practice Address - Street 1:4102 ASH CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2154
Practice Address - Country:US
Practice Address - Phone:757-650-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10464103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst