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NPI Code Detail

MEDICARE: MRS. HOLLY LORAYNE JENSEN

MEDICARE:  MRS. HOLLY LORAYNE JENSEN
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
1235Z00000XSpeech-Language Pathologist146006862IL

General Provider Information

NPI Number : 1629391669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HOLLY LORAYNE JENSEN
Provider Business Mailing Address
First Line : 940 MAPLE RD
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-2061
Country : US
Telephone Number : 708-799-0244
Fax Number :
Provider Business Practice Location Address
First Line : 940 MAPLE RD
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-2061
Country : US
Telephone Number : 708-799-0244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2010
Last Update Date : 03/04/2010

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Directions to “ MRS. HOLLY LORAYNE JENSEN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.