Provider Demographics
NPI:1922564681
Name:JENSEN, CHASITY LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:LYNN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 CLOVERLANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1633
Mailing Address - Country:US
Mailing Address - Phone:309-635-8476
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST STE 401
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:734-219-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011039031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical