# KELLIE J JENSEN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023362035
- **Authorized official:** KELLIE J JENSEN LCSW (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (307) 217-1311

## Contact information

- **Practice address:** 729 FORT ST, BUFFALO, WY 82834-2316
- **Practice address phone:** (307) 217-1311
- **Practice address fax:** (307) 684-2182
- **Mailing address:** 729 FORT ST, BUFFALO, WY 82834-2316
- **Mailing address phone:** (307) 217-1311
- **Mailing address fax:** (307) 684-2182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 661 | WY | Yes |

## Other

- **Enumeration date:** 10/30/2012
- **Last updated:** 10/30/2012