Healthcare Provider Details

I. General information

NPI: 1841740537
Provider Name (Legal Business Name): KIMBERLY JENSEN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE SUITE 1100
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

101 W 8TH AVE SUITE 1100
SPOKANE WA
99204-2307
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-4058
  • Fax: 509-474-6198
Mailing address:
  • Phone: 509-474-4058
  • Fax: 509-474-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGP60669178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: