Individual
MR. GERALD EDWARD JENSEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LP
Contact information
Practice address
2155 ANTLER DR SW, BRAINERD, MN 56401-2589
(218) 822-3736
Mailing address
PO BOX 2633, BAXTER, MN 56425-2633
(218) 822-3736
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4642
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP4642
MN PSYCHOLOGY LICENSE
MN
Enumeration date
05/24/2005
Last updated
02/06/2020
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