Healthcare Provider Details

I. General information

NPI: 1801713433
Provider Name (Legal Business Name): ERIC JENSEMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N BLACKHAWK AVE STE 215
MADISON WI
53705-3357
US

IV. Provider business mailing address

205 BREUNIG BLVD
WAUNAKEE WI
53597-8738
US

V. Phone/Fax

Practice location:
  • Phone: 608-235-5775
  • Fax:
Mailing address:
  • Phone: 608-235-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: