Provider Demographics
NPI:1609131580
Name:JENSON, DAWN M (LMT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:JENSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19753 RIVER RD
Mailing Address - Street 2:#C
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2215
Mailing Address - Country:US
Mailing Address - Phone:503-567-4263
Mailing Address - Fax:
Practice Address - Street 1:19753 RIVER RD
Practice Address - Street 2:#C
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2215
Practice Address - Country:US
Practice Address - Phone:503-567-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist