MEDICARE: ANNIE MORTENSEN 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1821822636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MORTENSEN JENSEN

Provider Business Mailing Address
First Line	:	14607 442ND AVE SE
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8611
Country	:	US
Telephone Number	:	801-228-8535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 STILSON AVE SE
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-9559
Country	:	US
Telephone Number	:	801-228-8535
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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Directions to “ ANNIE MORTENSEN JENSEN ” Practice Location

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