Provider Demographics
NPI:1649977729
Name:JENSEN, KYLE
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 E BONNIE BRAE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3016
Mailing Address - Country:US
Mailing Address - Phone:385-244-8050
Mailing Address - Fax:
Practice Address - Street 1:11616 S STATE ST STE 1505
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7125
Practice Address - Country:US
Practice Address - Phone:801-432-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker