Healthcare Provider Details

I. General information

NPI: 1043805468
Provider Name (Legal Business Name): KATELYN JENSEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE JENSEN

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W LOCKWOOD AVE STE 204
WEBSTER GROVES MO
63119-2945
US

IV. Provider business mailing address

103 W LOCKWOOD AVE STE 204
WEBSTER GROVES MO
63119-2945
US

V. Phone/Fax

Practice location:
  • Phone: 314-441-6605
  • Fax:
Mailing address:
  • Phone: 314-441-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: