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General NPI Number Information
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NPI Number | 1467722801
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Entity Type | Organization
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Legal Business Name | ALICIA JENSEN INC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 27 RED OAKS SHOPPING CTR
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City | RONCEVERTE
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State | WV
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Zip | 24970-1348
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Country | US
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Telephone | 304-645-1163
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Fax | 304-645-8045
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Provider Business Mailing Address
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Address Line | 346 DONALDSON AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78201-4905
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Country | US
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Telephone | 210-877-8509
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ALICIA JENSEN
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Credential | MOTR
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Telephone | 210-878-5091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | WV
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