Healthcare Provider Details

I. General information

NPI: 1366378978
Provider Name (Legal Business Name): HEATHER LYNN JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E COTTONWOOD RD
DOTHAN AL
36301-3670
US

IV. Provider business mailing address

906 E COTTONWOOD RD
DOTHAN AL
36301-3670
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-4629
  • Fax:
Mailing address:
  • Phone: 970-361-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: