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NPI Code Detail

MEDICARE: KIM JENSEN

MEDICARE: KIM JENSEN
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
1106H00000XMarriage & Family TherapistT1124OR

General Provider Information

NPI Number : 1245467869
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM JENSEN
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number :
Provider Business Practice Location Address
First Line : 3200 JUANIPERO WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8580
Country : US
Telephone Number : 541-816-4131
Fax Number : 458-226-2163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2009
Last Update Date : 06/03/2025

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Directions to “ KIM JENSEN ” Practice Location

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