MEDICARE: ANNE MARIE JENSEN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	600	IA
2	103T00000X	Psychologist	00600	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73012	OTHER	IA	BCBS OF IOWA

General Provider Information

NPI Number	:	1093827230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE JENSEN PHD

Provider Business Mailing Address
First Line	:	3068 WINTERGREEN DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4764
Country	:	US
Telephone Number	:	319-321-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3068 WINTERGREEN DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4764
Country	:	US
Telephone Number	:	319-321-7005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/20/2023

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