Provider Demographics
NPI:1932522059
Name:JENSEN, KATHY (LISW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-1344
Mailing Address - Country:US
Mailing Address - Phone:563-327-0172
Mailing Address - Fax:563-324-2437
Practice Address - Street 1:1202 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1344
Practice Address - Country:US
Practice Address - Phone:563-327-0172
Practice Address - Fax:563-324-2437
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA056471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical