Healthcare Provider Details

I. General information

NPI: 1467144238
Provider Name (Legal Business Name): SPENCER LYNN JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 REDWING RD STE 120
FORT COLLINS CO
80526-6310
US

IV. Provider business mailing address

2627 REDWING RD STE 120
FORT COLLINS CO
80526-6310
US

V. Phone/Fax

Practice location:
  • Phone: 970-818-2355
  • Fax:
Mailing address:
  • Phone: 970-818-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0003258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: