Provider Demographics
NPI:1235915836
Name:JENSEN, COURTNEY M (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 S MYERS ST APT B
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3931
Mailing Address - Country:US
Mailing Address - Phone:303-884-4405
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE STE 123
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1327
Practice Address - Country:US
Practice Address - Phone:760-529-4975
Practice Address - Fax:760-529-4761
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist