Provider Demographics
NPI:1912387754
Name:JENSEN, LISA ANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2631
Mailing Address - Country:US
Mailing Address - Phone:815-751-5790
Mailing Address - Fax:
Practice Address - Street 1:1415 LEWIS ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2631
Practice Address - Country:US
Practice Address - Phone:815-751-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional