Provider Demographics
NPI:1649617648
Name:PAS-JENSEN, JADE NATALIA (LISW-S)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NATALIA
Last Name:PAS-JENSEN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 SPOKANE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3830
Mailing Address - Country:US
Mailing Address - Phone:216-210-4859
Mailing Address - Fax:
Practice Address - Street 1:25701 N LAKELAND BLVD STE 403
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2453
Practice Address - Country:US
Practice Address - Phone:216-273-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1500997-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical