Provider Demographics
NPI:1376052050
Name:JENSEN, ANITA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 RIDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3655
Mailing Address - Country:US
Mailing Address - Phone:503-636-1381
Mailing Address - Fax:
Practice Address - Street 1:2003 RIDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3655
Practice Address - Country:US
Practice Address - Phone:503-636-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist