Individual
MARK JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 291-1620
Mailing address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8012-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8012-123
STATE LICENSE
WI
Enumeration date
06/23/2014
Last updated
06/23/2014
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