Individual
MR. MIKE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRES.
Contact information
Practice address
3480 WASHINGTON BLVD STE 107, OGDEN, UT 84401-4152
(801) 528-7350
(801) 528-7355
Mailing address
3480 WASHINGTON BLVD STE 107, OGDEN, UT 84401-4152
(801) 528-7350
(801) 528-7355
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13746360
UTAH TAX CERTIFICATE
UT
Enumeration date
01/15/2014
Last updated
01/15/2014
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