Provider Demographics
NPI:1093591836
Name:JENSEN, BROOKLYN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
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 1:2907 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6800
Mailing Address - Country:US
Mailing Address - Phone:501-317-9166
Mailing Address - Fax:
Practice Address - Street 1:23247 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2571
Practice Address - Country:US
Practice Address - Phone:501-377-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist