Individual
MRS. MARIA G JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, ICADC
Contact information
Practice address
2975 OVERLAND AVE, BURLEY, ID 83318-3231
(208) 878-2600
(208) 878-1336
Mailing address
2975 OVERLAND AVE, BURLEY, ID 83318-3231
(208) 878-2600
(208) 878-1336
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10256980
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
N-15573
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028634
REGENCE BLUE SHIELD
ID
Enumeration date
02/11/2008
Last updated
02/11/2008
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