Provider Demographics
NPI:1124338553
Name:JENSEN, JARED R (CSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:R
Last Name:JENSEN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 W BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2203
Mailing Address - Country:US
Mailing Address - Phone:801-676-8921
Mailing Address - Fax:801-208-1987
Practice Address - Street 1:1358 W BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2203
Practice Address - Country:US
Practice Address - Phone:801-676-8921
Practice Address - Fax:801-208-1987
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5081673-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health