Healthcare Provider Details

I. General information

NPI: 1083498166
Provider Name (Legal Business Name): JIL W. JENSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14890 LEGACY OAKS DR
CARMEL IN
46032-0045
US

IV. Provider business mailing address

14890 LEGACY OAKS DR
CARMEL IN
46032-0045
US

V. Phone/Fax

Practice location:
  • Phone: 240-475-0143
  • Fax:
Mailing address:
  • Phone: 240-475-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JIL WHITTLE JENSEN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW-C
Phone: 301-498-7569