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NPI Code Detail

MEDICARE: DYLAN JENSEN

MEDICARE: DYLAN 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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1972869170
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN JENSEN
Provider Business Mailing Address
First Line : 7759 SE 72ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-7921
Country : US
Telephone Number : 503-788-4500
Fax Number :
Provider Business Practice Location Address
First Line : 7759 SE 72ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-7921
Country : US
Telephone Number : 503-788-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2012
Last Update Date : 03/29/2019

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Directions to “ DYLAN JENSEN ” Practice Location

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