Healthcare Provider Details

I. General information

NPI: 1518451301
Provider Name (Legal Business Name): TIFFANY JENSEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12608 STATE RD STE 1
NORTH ROYALTON OH
44133-3281
US

IV. Provider business mailing address

12608 STATE RD STE 1
NORTH ROYALTON OH
44133-3281
US

V. Phone/Fax

Practice location:
  • Phone: 440-907-1141
  • Fax: 440-345-3456
Mailing address:
  • Phone: 440-907-1141
  • Fax: 440-345-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08796
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08796
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: