Provider Demographics
NPI:1164410924
Name:JENS, DANIEL E (LISW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:JENS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 TECH DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3262
Mailing Address - Country:US
Mailing Address - Phone:563-355-1611
Mailing Address - Fax:563-355-6617
Practice Address - Street 1:2485 TECH DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3262
Practice Address - Country:US
Practice Address - Phone:563-355-1611
Practice Address - Fax:563-355-6617
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA032131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical