Healthcare Provider Details

I. General information

NPI: 1750528766
Provider Name (Legal Business Name): HEIDI LYN JENSEN MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI LYN PETERSEN MS, RD, LD

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 HUEBNER RD STE 202
SAN ANTONIO TX
78240-1776
US

IV. Provider business mailing address

9618 HUEBNER RD STE 202
SAN ANTONIO TX
78240-1776
US

V. Phone/Fax

Practice location:
  • Phone: 201-651-0303
  • Fax: 210-651-0302
Mailing address:
  • Phone: 201-651-0303
  • Fax: 210-651-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT80952
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: