Provider Demographics
NPI:1700198363
Name:JENSEN, SUSAN MCQUIRK (MA,CCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCQUIRK
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 E PORTALS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6221
Mailing Address - Country:US
Mailing Address - Phone:559-289-3443
Mailing Address - Fax:
Practice Address - Street 1:758 E PORTALS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6221
Practice Address - Country:US
Practice Address - Phone:559-289-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist