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NPI Code Detail

MEDICARE: VANESSA K JENSEN PSYD

MEDICARE: VANESSA K JENSEN PSYD
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
1103T00000XPsychologist3911OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194788984
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA K JENSEN PSYD
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 800-223-2273
Fax Number :
Provider Business Practice Location Address
First Line : 2785 SOM CENTER RD
Second Line :
City : WILLOUGHBY HILLS
State : OH
Zip : 44094-6501
Country : US
Telephone Number : 800-223-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 11/11/2021

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