Individual
TRISTA MARIE JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPA, BA-SOCIAL WORK
Contact information
Practice address
526 RAVEN WAY APT A, CHUBBUCK, ID 83202-1926
(208) 380-0978
Mailing address
526 RAVEN WAY APT A, CHUBBUCK, ID 83202-1926
(208) 380-0978
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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