Provider Demographics
NPI:1295723849
Name:JENSEN, LAURIE ANNE (ATC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 SHEARD RD
Mailing Address - Street 2:
Mailing Address - City:KANSASVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53139-9401
Mailing Address - Country:US
Mailing Address - Phone:262-534-9162
Mailing Address - Fax:
Practice Address - Street 1:2001 ALFORD PARK DR
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1929
Practice Address - Country:US
Practice Address - Phone:262-551-6104
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer