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NPI Code Detail

MEDICARE: DENISE R JENSEN CSW

MEDICARE: DENISE R JENSEN CSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7355798-3502UT

General Provider Information

NPI Number : 1083937007
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE R JENSEN CSW
Provider Business Mailing Address
First Line : 195 N 1950 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-3100
Country : US
Telephone Number : 801-419-2750
Fax Number :
Provider Business Practice Location Address
First Line : 195 N 1950 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-3100
Country : US
Telephone Number : 801-419-2750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2010
Last Update Date : 08/25/2015

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