Provider Demographics
NPI:1043651797
Name:JENSEN, MICHELLE LEIGH (RSA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:LESSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RSA
Mailing Address - Street 1:14204 W GOLDMINE RD
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61062-9122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1126 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1469
Practice Address - Country:US
Practice Address - Phone:815-244-4200
Practice Address - Fax:815-244-4202
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health