Provider Demographics
NPI:1487710935
Name:JENSEN, CRAIG C (PH D)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:C
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 164TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4918
Mailing Address - Country:US
Mailing Address - Phone:425-743-6066
Mailing Address - Fax:425-745-1746
Practice Address - Street 1:6803 164TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4918
Practice Address - Country:US
Practice Address - Phone:425-743-6066
Practice Address - Fax:425-743-6066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000771103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral