Provider Demographics
NPI:1083216063
Name:JENS, MICHAELA ANN
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ANN
Last Name:JENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-8006
Mailing Address - Country:US
Mailing Address - Phone:402-650-6568
Mailing Address - Fax:
Practice Address - Street 1:4309 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3423
Practice Address - Country:US
Practice Address - Phone:515-996-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099610104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker