Provider Demographics
NPI:1669707345
Name:JENSEN, JACQUELINE GABRIELE (LPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:GABRIELE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 SE POWELL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2069
Mailing Address - Country:US
Mailing Address - Phone:971-271-4237
Mailing Address - Fax:
Practice Address - Street 1:2740 SE POWELL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2069
Practice Address - Country:US
Practice Address - Phone:971-271-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional