Healthcare Provider Details

I. General information

NPI: 1609392927
Provider Name (Legal Business Name): KAYLEE NICOLE JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

1624 SANTA CLARA DR STE 145
ROSEVILLE CA
95661-3500
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: