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NPI Code Detail

MEDICARE: KIMBERLY JENSEN

MEDICARE:   KIMBERLY  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
1101YM0800XMental Health Counselor11784059-3501UT

General Provider Information

NPI Number : 1689457756
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JENSEN
Provider Business Mailing Address
First Line : 7174 S BREEZE HILL RD
Second Line :
City : WEST JORDAN
State : UT
Zip : 84081-3928
Country : US
Telephone Number : 801-824-8089
Fax Number :
Provider Business Practice Location Address
First Line : 1234 W SOUTH JORDAN PKWY STE B2
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4649
Country : US
Telephone Number : 801-821-4501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2023
Last Update Date : 08/18/2023

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Directions to “ KIMBERLY JENSEN ” Practice Location

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