Provider Demographics
NPI:1205232352
Name:JENSEN, JACQUELYN BETH (MSW, LISAC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:BETH
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W ENCANTO BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1132
Mailing Address - Country:US
Mailing Address - Phone:602-573-1661
Mailing Address - Fax:
Practice Address - Street 1:41 W ENCANTO BLVD APT 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1132
Practice Address - Country:US
Practice Address - Phone:602-573-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)