Provider Demographics
NPI:1912205501
Name:JENSEN, KRISTEN JANELLE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JANELLE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28546 GIBRALTAR LN
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3825
Mailing Address - Country:US
Mailing Address - Phone:661-317-5300
Mailing Address - Fax:
Practice Address - Street 1:28546 GIBRALTAR LN
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3825
Practice Address - Country:US
Practice Address - Phone:661-317-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
CA1-13-14255103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst