MEDICARE: MS. WENDY K JENSEN LCSW

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	1041C0700X	Clinical Social Worker	2168	OR

General Provider Information

NPI Number	:	1659437333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY K JENSEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 86684
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97286-0684
Country	:	US
Telephone Number	:	503-624-1111
Fax Number	:	503-774-3996

Provider Business Practice Location Address
First Line	:	9860 SW HALL BLVD
Second Line	:	SUITE B
City	:	TIGARD
State	:	OR
Zip	:	97223-8896
Country	:	US
Telephone Number	:	503-624-1111
Fax Number	:	503-774-3996

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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