Provider Demographics
NPI:1609298991
Name:JENSEN, ROBERT JOSIAH
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSIAH
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18806 58TH ST E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8805
Mailing Address - Country:US
Mailing Address - Phone:253-830-4119
Mailing Address - Fax:
Practice Address - Street 1:15324 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2698
Practice Address - Country:US
Practice Address - Phone:253-830-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60664658101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor