Provider Demographics
NPI:1811057474
Name:JENSE, PAMELA R (MA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:JENSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 WETHERSFIELD XING
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8719
Mailing Address - Country:US
Mailing Address - Phone:304-550-2345
Mailing Address - Fax:304-766-4899
Practice Address - Street 1:BARRON DRIVE
Practice Address - Street 2:WVDRS
Practice Address - City:INSTITUTE
Practice Address - State:WV
Practice Address - Zip Code:25112
Practice Address - Country:US
Practice Address - Phone:304-766-4899
Practice Address - Fax:304-766-4899
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical