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General NPI Number Information
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NPI Number | 1841643087
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Entity Type | Individual
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Provider Name | BYRON KENT JENSEN
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 137 W MAIN ST
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City | TREMONTON
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State | UT
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Zip | 84337-1629
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Country | US
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Telephone | 435-279-4980
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Fax | 435-921-0801
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Provider Business Mailing Address
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Address Line | 137 W MAIN ST
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City | TREMONTON
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State | UT
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Zip | 84337-1629
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Country | US
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Telephone | 435-279-4980
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Fax | 435-921-0801
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 9-723180-0
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License Number State | UT
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