Healthcare Provider Details

I. General information

NPI: 1841264082
Provider Name (Legal Business Name): KATHY F JENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NEVADA HIGHWAY #3
BOULDER CITY NV
89005
US

IV. Provider business mailing address

916 NEVADA HIGHWAY #3
BOULDER CITY NV
89005
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-2866
  • Fax: 702-294-3073
Mailing address:
  • Phone: 702-294-2866
  • Fax: 702-294-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2678C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: