Provider Demographics
NPI:1467722801
Name:ALICIA JENSEN INC
Entity type:Organization
Organization Name:ALICIA JENSEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR
Authorized Official - Phone:210-878-5091
Mailing Address - Street 1:346 DONALDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4905
Mailing Address - Country:US
Mailing Address - Phone:210-877-8509
Mailing Address - Fax:
Practice Address - Street 1:27 RED OAKS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1348
Practice Address - Country:US
Practice Address - Phone:304-645-1163
Practice Address - Fax:304-645-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency