Provider Demographics
NPI:1790496271
Name:JENSEN, MONTANA B (LMSW)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1701
Mailing Address - Country:US
Mailing Address - Phone:573-723-1100
Mailing Address - Fax:573-723-1130
Practice Address - Street 1:504 VILLAR ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1042
Practice Address - Country:US
Practice Address - Phone:573-910-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025044483104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker