Provider Demographics
NPI:1952641763
Name:JENSEN, CHERLYN
Entity Type:Individual
Prefix:
First Name:CHERLYN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1091 WAIKAPOO ST # 206
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6494
Mailing Address - Country:US
Mailing Address - Phone:808-478-1981
Mailing Address - Fax:
Practice Address - Street 1:91-1091 WAIKAPOO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6494
Practice Address - Country:US
Practice Address - Phone:808-478-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst