Healthcare Provider Details

I. General information

NPI: 1093675191
Provider Name (Legal Business Name): ALYSSA JENSEN RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

IV. Provider business mailing address

2830 SE GLENN ST
CORVALLIS OR
97333-2165
US

V. Phone/Fax

Practice location:
  • Phone: 541-258-2101
  • Fax:
Mailing address:
  • Phone: 541-609-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number1070943
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: