Individual
DEREK JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 W COTA ST, SHELTON, WA 98584-2265
(510) 337-7950
Mailing address
307 W COTA ST, SHELTON, WA 98584-2265
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/09/2019
Last updated
12/18/2019
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