Provider Demographics
NPI:1972637577
Name:MCDONOUGH-JENSEN, KAY
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MCDONOUGH-JENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, DIPLCH
Mailing Address - Street 1:214 W TOWNE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1743
Mailing Address - Country:US
Mailing Address - Phone:409-377-7723
Mailing Address - Fax:
Practice Address - Street 1:214 W TOWNE ST
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1743
Practice Address - Country:US
Practice Address - Phone:409-377-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT137171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist