Healthcare Provider Details

I. General information

NPI: 1144735465
Provider Name (Legal Business Name): KATHLEEN LYNN GILLESPIE-JENSEN MA, MS, TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E WASHINGTON ST
CLARINDA IA
51632-1625
US

IV. Provider business mailing address

200 N CENTER ST
SHENANDOAH IA
51601-1322
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-3501
  • Fax: 712-542-4725
Mailing address:
  • Phone: 712-209-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number089612
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: