Healthcare Provider Details

I. General information

NPI: 1699603688
Provider Name (Legal Business Name): KADE MARTIN JENSEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 E GALA ST STE 3
MERIDIAN ID
83642-7692
US

IV. Provider business mailing address

2321 E GALA ST STE 3
MERIDIAN ID
83642-7692
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-5848
  • Fax: 208-888-0884
Mailing address:
  • Phone: 208-888-5848
  • Fax: 208-888-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861820
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: