Healthcare Provider Details

I. General information

NPI: 1710170782
Provider Name (Legal Business Name): MARCIA E. JENSEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE, R7.255
MINNEAPOLIS MN
55415
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-7479
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5966
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number60161843
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: