Healthcare Provider Details

I. General information

NPI: 1538098116
Provider Name (Legal Business Name): SARAH NICOLE JENSEN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 DENAIR ST
PASADENA CA
91107-1303
US

IV. Provider business mailing address

559 WOODBURY RD
GLENDALE CA
91206-2647
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5870
  • Fax:
Mailing address:
  • Phone: 626-396-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: