Provider Demographics
NPI:1992317135
Name:MCQUEEN-JENSEN, ROB
Entity type:Individual
Prefix:MR
First Name:ROB
Middle Name:
Last Name:MCQUEEN-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 1:1103 NE ELM ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1664
Mailing Address - Country:US
Mailing Address - Phone:541-323-5330
Mailing Address - Fax:
Practice Address - Street 1:1103 NE ELM ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1664
Practice Address - Country:US
Practice Address - Phone:541-323-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORQMHA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator