Individual
KELLY JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ICADC
Contact information
Practice address
255 DELAWARE AVE STE 3000, BUFFALO, NY 14202-2016
(716) 842-0440
Mailing address
255 DELAWARE AVE STE 3000, BUFFALO, NY 14202-2016
(716) 842-0440
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
827461
GU
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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