MEDICARE: WORKSMART CONSULTANTS, LLC

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
1	103TC0700X	Clinical Psychologist	4202	OH

General Provider Information

NPI Number	:	1508199399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORKSMART CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	2966 EATON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2516
Country	:	US
Telephone Number	:	216-751-0710
Fax Number	:	888-882-3680

Provider Business Practice Location Address
First Line	:	2966 EATON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2516
Country	:	US
Telephone Number	:	216-751-0710
Fax Number	:	888-882-3680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KURT WILLIAM JENSEN
Credential	:	PSY.D.
Telephone Number	:	216-751-0710

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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