Provider Information for 1154099588
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Ms. WANDA ETHEL JENSEN LCSW
Sex: Female
NPI: 1154099588
Last Updated: 2025-03-19
Certification Date: 2025-03-17
Certification Date: 2025-03-17
Details
| Name | Value | ||||||||||||
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| NPI | 1154099588 | ||||||||||||
| Enumeration Date | 2021-08-31 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 13 LIMA, MT 59739-0013 United States Phone: 406-660-0904 | Fax: | ||||||||||||
| Primary Practice Address | 120 W 3RD AVE LIMA, MT 59739 United States Phone: 406-660-0904 | Fax: | ||||||||||||
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