Provider Demographics
NPI:1609452184
Name:JENSEN, MAGGIE SUZANN (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:SUZANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4335
Mailing Address - Country:US
Mailing Address - Phone:605-689-0457
Mailing Address - Fax:
Practice Address - Street 1:311 CEDAR ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4335
Practice Address - Country:US
Practice Address - Phone:605-689-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12101554101YA0400X
SD5202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)