Healthcare Provider Details

I. General information

NPI: 1881761898
Provider Name (Legal Business Name): WENDY JENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 N STATE STREET
OREM UT
84057-2025
US

IV. Provider business mailing address

1790 N STATE STREET
OREM UT
84057-2025
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-8255
  • Fax: 801-224-8301
Mailing address:
  • Phone: 801-224-8255
  • Fax: 801-224-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number356380-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: