Provider Demographics
NPI:1255154373
Name:JENSEN, KATIE JANE (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JANE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16363 PEARL RD # 312
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6002
Mailing Address - Country:US
Mailing Address - Phone:440-316-2416
Mailing Address - Fax:
Practice Address - Street 1:16363 PEARL RD # 312
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6002
Practice Address - Country:US
Practice Address - Phone:440-316-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist