Provider Demographics
NPI:1417394099
Name:HOUGHTON, JENSINE
Entity Type:Individual
Prefix:
First Name:JENSINE
Middle Name:
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WOODHILL CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-9105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 WOODHILL CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9105
Practice Address - Country:US
Practice Address - Phone:763-684-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist