Provider Demographics
NPI:1285354530
Name:JENSEN, ANGELA SUE (MS/CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS/CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 SPRUCE MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8306
Mailing Address - Country:US
Mailing Address - Phone:181-526-0067
Mailing Address - Fax:
Practice Address - Street 1:604 LUCAS RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6623
Practice Address - Country:US
Practice Address - Phone:910-891-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist