Healthcare Provider Details

I. General information

NPI: 1124954623
Provider Name (Legal Business Name): CHELSIE JENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N BROADWAY STE 111
MINOT ND
58703-2378
US

IV. Provider business mailing address

2405 ACADEMY RD
MINOT ND
58703-1607
US

V. Phone/Fax

Practice location:
  • Phone: 701-537-4191
  • Fax: 701-425-0346
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2409
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: