Provider Demographics
NPI:1659979565
Name:JENSEN, ANGELA RENEE (MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3726 BEACH DR SW APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3017
Mailing Address - Country:US
Mailing Address - Phone:509-714-2219
Mailing Address - Fax:
Practice Address - Street 1:463 TREMONT ST W STE 110
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3743
Practice Address - Country:US
Practice Address - Phone:253-851-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLPI.SI.61101605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist