Doctor Name: | MARY PHYLLIS JENSEN |
NPI Number: | 1205257193 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP, MS |
License Number: | LL00002797 |
Business Practice Address: | 4690 Ne North Tolo Rd Bainbridge Island, WA - 981101429 |
Business Phone Number: | 2069133236 |
Business Fax Number: | |
Mailing Address: | 4690 Ne North Tolo Rd, BAINBRIDGE ISLAND |
State: | WA |
Postal Code: | 981101429 |
Phone Number: | 2069133236 |
Fax Number: | |
NPI Enumeration Date: | 12/19/2013 |
NPI Last Update Date: | 12/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL00002797 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |