MEDICARE: MRS. ABBIE OGAARD 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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1730420365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABBIE OGAARD JENSEN

Provider Business Mailing Address
First Line	:	2281 S 2000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5698 W GLEN EAGLE DR
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84128-4013
Country	:	US
Telephone Number	:	801-830-8248
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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