Provider Demographics
NPI:1376968966
Name:JENSEN, LEYNA (LAC)
Entity type:Individual
Prefix:
First Name:LEYNA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 NW ARBORETUM RD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9574
Mailing Address - Country:US
Mailing Address - Phone:503-853-0097
Mailing Address - Fax:
Practice Address - Street 1:2151 NW FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5624
Practice Address - Country:US
Practice Address - Phone:541-753-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150829171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist