Healthcare Provider Details

I. General information

NPI: 1841782232
Provider Name (Legal Business Name): JANCI JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 W CHESTNUT ST
ROGERS AR
72756-0351
US

IV. Provider business mailing address

4009 PASOFINO LOOP
SPRINGDALE AR
72764-1772
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax: 479-246-0606
Mailing address:
  • Phone: 417-389-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number200103
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: