Provider Demographics
NPI:1245336999
Name:JENSEN, RICHARD FREDERICK (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7922 OLYMPIC VIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6275
Mailing Address - Country:US
Mailing Address - Phone:253-358-6640
Mailing Address - Fax:253-851-3188
Practice Address - Street 1:7922 OLYMPIC VIEW DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6275
Practice Address - Country:US
Practice Address - Phone:253-358-6640
Practice Address - Fax:253-851-3188
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G001001904OtherMEDICARE PTAN
WA7017544Medicaid