Provider Demographics
NPI:1568029635
Name:CHASSI JENSEN LLC
Entity Type:Organization
Organization Name:CHASSI JENSEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:309-635-8476
Mailing Address - Street 1:4265 CLOVERLANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1633
Mailing Address - Country:US
Mailing Address - Phone:309-635-8476
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST STE 401
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:734-219-3851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health