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General NPI Number Information
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NPI Number | 1689457756
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Entity Type | Individual
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Provider Name | KIMBERLY JENSEN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 1234 W SOUTH JORDAN PKWY STE B2
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4649
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Country | US
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Telephone | 801-821-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 7174 S BREEZE HILL RD
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City | WEST JORDAN
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State | UT
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Zip | 84081-3928
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Country | US
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Telephone | 801-824-8089
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11784059-3501
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License Number State | UT
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