Provider Demographics
NPI:1497215305
Name:JENSEN, EMILY JORDAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JORDAN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1310 HIGHWAY 96 E STE 104C
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 HIGHWAY 96 E STE 104C
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3618
Practice Address - Country:US
Practice Address - Phone:651-243-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist