Provider Demographics
NPI:1588138937
Name:JENSEN, KIMBERLY CLAYTON (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CLAYTON
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 MARSHALL WAY STE A
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7388
Mailing Address - Country:US
Mailing Address - Phone:801-647-9920
Mailing Address - Fax:
Practice Address - Street 1:893 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7387
Practice Address - Country:US
Practice Address - Phone:801-647-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9421689-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical