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General NPI Number Information
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NPI Number | 1083081624
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Entity Type | Individual
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Provider Name | LINDA MARIE JENSEN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 101 SKI RD
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City | LIBBY
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State | MT
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Zip | 59923-2843
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Country | US
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Telephone | 406-293-2763
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Fax |
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Provider Business Mailing Address
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Address Line | 118 N 7TH ST STE B10
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2759
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Country | US
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Telephone | 208-819-2716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12329
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License Number State | MT
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