Provider Demographics
NPI:1538487111
Name:JENSEN, LORI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N GREENLEAF AVE.
Mailing Address - Street 2:SUITE 228
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3393
Mailing Address - Country:US
Mailing Address - Phone:630-688-1462
Mailing Address - Fax:847-263-5872
Practice Address - Street 1:135 N GREENLEAF AVE.
Practice Address - Street 2:SUITE 228
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:630-688-1462
Practice Address - Fax:847-263-5872
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical