Provider Demographics
NPI:1164552949
Name:JENSEN, LINDA KAY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ASH LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6286
Mailing Address - Country:US
Mailing Address - Phone:573-855-9783
Mailing Address - Fax:
Practice Address - Street 1:451 ASH LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6286
Practice Address - Country:US
Practice Address - Phone:573-855-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1020802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer