Provider Demographics
NPI:1831378678
Name:JENSEN, SHAWN KATHLEEN (LCPC)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:KATHLEEN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W EMERALD ST
Mailing Address - Street 2:STE. 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9055
Mailing Address - Country:US
Mailing Address - Phone:208-375-0752
Mailing Address - Fax:
Practice Address - Street 1:8100 W EMERALD ST
Practice Address - Street 2:STE. 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9055
Practice Address - Country:US
Practice Address - Phone:208-375-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional