Provider Demographics
NPI:1609811389
Name:JENSEN, LORI DENISE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DENISE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S JEFFERS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5351
Mailing Address - Country:US
Mailing Address - Phone:308-532-9111
Mailing Address - Fax:
Practice Address - Street 1:620 S JEFFERS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5351
Practice Address - Country:US
Practice Address - Phone:308-532-9111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3006101YM0800X
NE11911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025054200Medicaid
NE099560Medicare ID - Type UnspecifiedIDENTIFICATION NUMBER