Provider Demographics
NPI:1720229735
Name:JENSEN, TAMMY L (LMP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2913
Mailing Address - Country:US
Mailing Address - Phone:360-423-3399
Mailing Address - Fax:360-423-6181
Practice Address - Street 1:1815 HUDSON ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2913
Practice Address - Country:US
Practice Address - Phone:360-423-3399
Practice Address - Fax:360-423-6181
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist