Doctor Name: | NICOLE F JENSEN |
NPI Number: | 1023276417 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 3639 |
Business Practice Address: | 8901 W Lincoln Ave West Allis, WI - 532272409 |
Business Phone Number: | 4143295657 |
Business Fax Number: | 4143295637 |
Mailing Address: | 1220 Dewey Ave, WAUWATOSA |
State: | WI |
Postal Code: | 532132504 |
Phone Number: | 4144546779 |
Fax Number: | 4144546450 |
NPI Enumeration Date: | 06/02/2008 |
NPI Last Update Date: | 06/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |