Provider Demographics
NPI:1609237601
Name:JENSEN, SHARON KELLY (CCC SLP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KELLY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KELLY
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BEST RD
Mailing Address - Street 2:
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106-2309
Mailing Address - Country:US
Mailing Address - Phone:518-212-7749
Mailing Address - Fax:
Practice Address - Street 1:51 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1718
Practice Address - Country:US
Practice Address - Phone:518-828-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist