Individual
JENSEN PENDRY SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1959 N PEACE HAVEN RD # 104, WINSTON SALEM, NC 27106-4850
(336) 560-7878
Mailing address
2333 AUTUMN MIST DR, WINSTON SALEM, NC 27103-7061
(336) 469-9032
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-41979
NC
106S00000X
Behavior Technician
RBT-18-58110
NC
Other
Enumeration date
06/15/2018
Last updated
07/02/2020
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