Provider Demographics
NPI:1356918353
Name:JENSEN, JUSTIN (AUD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ASH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9316
Mailing Address - Country:US
Mailing Address - Phone:916-390-6583
Mailing Address - Fax:
Practice Address - Street 1:250 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1025
Practice Address - Country:US
Practice Address - Phone:319-335-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist