Provider Demographics
NPI:1720084890
Name:JENSEN, DONNA MAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MAE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5796 CLARK ROAD SUITE 8
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969
Mailing Address - Country:US
Mailing Address - Phone:530-873-1297
Mailing Address - Fax:
Practice Address - Street 1:5796 CLARK RD
Practice Address - Street 2:STE 8
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5152
Practice Address - Country:US
Practice Address - Phone:530-877-0244
Practice Address - Fax:530-877-0241
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 195681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20949ZMedicare PIN