MEDICARE: ELIZABETH JENSEN MA, CCC-SLP

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1982002994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JENSEN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1680 MOUNT TREMBLANT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2401
Country	:	US
Telephone Number	:	702-401-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 MOUNT TREMBLANT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2401
Country	:	US
Telephone Number	:	702-401-1743
Fax Number	:

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

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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Directions to “ ELIZABETH JENSEN MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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