Provider Demographics
NPI:1902041973
Name:JENSEN, TAMMIE LYNNE (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:LYNNE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51275 VILLAGE EDGE E APT 308
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1322
Mailing Address - Country:US
Mailing Address - Phone:586-260-4191
Mailing Address - Fax:
Practice Address - Street 1:14145 SIMONE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3228
Practice Address - Country:US
Practice Address - Phone:586-566-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist