Provider Demographics
NPI:1164856217
Name:JENSEN, HILARY JANE
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:JANE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:JANE
Other - Last Name:BRODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4387 HARRISON BLVD STE C4
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3270
Mailing Address - Country:US
Mailing Address - Phone:801-387-4970
Mailing Address - Fax:
Practice Address - Street 1:4387 HARRISON BLVD STE C4
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3270
Practice Address - Country:US
Practice Address - Phone:801-387-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8982090-2501103TC0700X
UT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical