Provider Demographics
NPI:1093174773
Name:JENSEN, GRACE (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N 206TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-7015
Mailing Address - Country:US
Mailing Address - Phone:402-289-2559
Mailing Address - Fax:
Practice Address - Street 1:3100 N 206TH ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-7015
Practice Address - Country:US
Practice Address - Phone:402-289-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist