MEDICARE: KATRINA M. JENSEN M.A

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	235Z00000X	Speech-Language Pathologist	103842	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00814318	OTHER	TX	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558402198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA M. JENSEN M.A

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-920-0068

Provider Business Practice Location Address
First Line	:	923 PENNSYLVANIA AVE SUITE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2254
Country	:	US
Telephone Number	:	817-920-0484
Fax Number	:	817-920-0068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	09/30/2011

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Directions to “ KATRINA M. JENSEN M.A” Practice Location

Language	Start Address	Practice Location

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