Provider Demographics
NPI:1346834553
Name:JENSEN, ALEXANDRA ANN ODETTE (CSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANN ODETTE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 E 4800 S STE 220
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5533
Mailing Address - Country:US
Mailing Address - Phone:801-262-5418
Mailing Address - Fax:
Practice Address - Street 1:835 E 4800 S STE 220
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5533
Practice Address - Country:US
Practice Address - Phone:801-262-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9614747-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker