Individual
KEITH THOMAS JENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
94 E PAGES LN, #A, CENTERVILLE, UT 84014-2216
(801) 294-0578
Mailing address
1359 NOLA DR, CENTERVILLE, UT 84014-1234
(801) 397-1187
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/16/2009
Last updated
10/16/2009
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