Provider Demographics
NPI:1851487276
Name:JENSEN, HEIDI KAY (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KAY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:KAY
Other - Last Name:MARHULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2424 32ND AVE S
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6545
Mailing Address - Country:US
Mailing Address - Phone:701-746-6336
Mailing Address - Fax:701-772-1030
Practice Address - Street 1:2424 32ND AVE S
Practice Address - Street 2:STE 202
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6545
Practice Address - Country:US
Practice Address - Phone:701-746-6336
Practice Address - Fax:701-772-1030
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN309K8JEOtherBLUECROSSBLUESHIELD OF MN
ND1454859Medicaid
ND61-93978OtherUBH (MEDICA)
ND10986Medicaid
ND24742OtherBLUECROSSBLUESHIELD OF ND
ND16349OtherPREFERRED ONE
ND10986Medicaid