Provider Demographics
NPI:1912608134
Name:JENSEN, SARAH JANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:GEDDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3728 S 800 W
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-5668
Mailing Address - Country:US
Mailing Address - Phone:208-530-9690
Mailing Address - Fax:
Practice Address - Street 1:3728 S 800 W
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-5668
Practice Address - Country:US
Practice Address - Phone:208-530-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist