Healthcare Provider Details

I. General information

NPI: 1255982872
Provider Name (Legal Business Name): KRYSTA JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COHASSET LN
CRANSTON RI
02921-1364
US

IV. Provider business mailing address

25 COHASSET LN
CRANSTON RI
02921-1364
US

V. Phone/Fax

Practice location:
  • Phone: 207-616-1127
  • Fax: 401-414-0706
Mailing address:
  • Phone: 401-475-0653
  • Fax: 401-414-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02025
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: