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NPI Code Detail

MEDICARE: GERALD E. JENSEN, JR.

MEDICARE: GERALD E. JENSEN, JR.
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
1103T00000XPsychologistLP 4642MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871596585
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERALD E. JENSEN, JR.
Provider Business Mailing Address
First Line : PO BOX 2633
Second Line :
City : BAXTER
State : MN
Zip : 56425-2633
Country : US
Telephone Number : 218-822-3736
Fax Number : 218-822-3761
Provider Business Practice Location Address
First Line : 6980 FAIRVIEW RD
Second Line : SUITE 110
City : BAXTER
State : MN
Zip : 56425-7836
Country : US
Telephone Number : 218-822-3736
Fax Number : 218-822-3761
Authorized Official
Title or Position : DIRECTOR
Name : JERRY E. JENSEN
Credential : MA, LP
Telephone Number : 218-822-3736
Provider Enumeration Date : 05/27/2005
Last Update Date : 02/10/2009

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