Provider Demographics
NPI:1063994119
Name:JENSEN, NICHOLAS (LCGC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E MARSHALL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5414
Mailing Address - Country:US
Mailing Address - Phone:610-732-6739
Mailing Address - Fax:610-738-2540
Practice Address - Street 1:440 E MARSHALL ST STE 201
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-732-6739
Practice Address - Fax:610-738-2540
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS