Provider Demographics
NPI:1578846101
Name:HENSLEY, ROSA JUNG (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:JUNG
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 B ST STE 305
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5941
Mailing Address - Country:US
Mailing Address - Phone:907-921-1331
Mailing Address - Fax:907-802-6630
Practice Address - Street 1:4141 B ST STE 305
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5941
Practice Address - Country:US
Practice Address - Phone:907-921-1331
Practice Address - Fax:907-802-6630
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1443291041C0700X, 1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN/AOtherBLUE CROSS BLUE SHILED