Provider Demographics
NPI:1225874381
Name:JENSEN, ALEXIS ROSE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ROSE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 TALLMAN CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8441
Mailing Address - Country:US
Mailing Address - Phone:616-821-5722
Mailing Address - Fax:
Practice Address - Street 1:3349 CENTURY CENTER ST SW STE 3353
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3109
Practice Address - Country:US
Practice Address - Phone:616-344-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician