Provider Demographics
NPI:1154585313
Name:JENSEN, LISA J (LIC AC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 IVY CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1770
Mailing Address - Country:US
Mailing Address - Phone:857-998-0385
Mailing Address - Fax:
Practice Address - Street 1:175 WASHINGTON ST STE B21
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2143
Practice Address - Country:US
Practice Address - Phone:857-998-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222848171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist