Individual
MR. JEREMIAH E. JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1726 BEVERLY AVE, KINGMAN VA CBOC, KINGMAN, AZ 86401
(928) 692-0080
Mailing address
PO BOX 422, YUCCA, AZ 86438-0422
(928) 897-5744
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW12180
AZ
Other
Enumeration date
01/30/2009
Last updated
01/30/2009
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