Provider Demographics
NPI:1447815584
Name:JENSEN, SARA (MA, LPC, LLMFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA, LPC, LLMFT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WADLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLPC, LLMFT
Mailing Address - Street 1:121 S BOWER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1501
Mailing Address - Country:US
Mailing Address - Phone:989-289-0693
Mailing Address - Fax:
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1286
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006858101YP2500X
MI6401017278101YP2500X
MI6401019616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional