Provider Demographics
NPI:1316620669
Name:JENSEN, KEITH W
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WASHINTON AVE.
Mailing Address - Street 2:STE. 030
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-8717
Mailing Address - Country:US
Mailing Address - Phone:989-225-7101
Mailing Address - Fax:
Practice Address - Street 1:203 S WASHINTON AVE.
Practice Address - Street 2:STE. 030
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-8717
Practice Address - Country:US
Practice Address - Phone:989-225-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician