Provider Demographics
NPI:1710752365
Name:JENSEN, SETH DONALD
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:DONALD
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 1:3599 E SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8507
Mailing Address - Country:US
Mailing Address - Phone:989-209-3245
Mailing Address - Fax:989-209-3246
Practice Address - Street 1:203 S WASHINGTON AVE STE 30
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1217
Practice Address - Country:US
Practice Address - Phone:989-209-3245
Practice Address - Fax:989-209-3246
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician