Healthcare Provider Details

I. General information

NPI: 1053431791
Provider Name (Legal Business Name): SHARLET LEE JENSEN MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

IV. Provider business mailing address

23801B WALLITNER RD
ARLINGTON WA
98223-6860
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-7570
  • Fax: 360-416-7580
Mailing address:
  • Phone: 360-435-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004205
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: