Provider Demographics
NPI:1871760355
Name:JENSEN, STEPHANIE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 4TH ST
Mailing Address - Street 2:SUITE 321
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1750
Mailing Address - Country:US
Mailing Address - Phone:712-301-4518
Mailing Address - Fax:712-276-3314
Practice Address - Street 1:600 4TH ST
Practice Address - Street 2:SUITE 321
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1750
Practice Address - Country:US
Practice Address - Phone:712-301-4518
Practice Address - Fax:712-276-3314
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2666101YM0800X
NE103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool