Individual
SHANE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 22ND AVE S, MINNEAPOLIS, MN 55454-1315
(612) 330-1170
Mailing address
610 22ND AVE S, MINNEAPOLIS, MN 55454-1315
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304481
MN
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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