Provider Demographics
NPI:1902307531
Name:JENSEN, LOIS (MSW, CDPT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSW, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 S SPOTTED RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5728
Mailing Address - Country:US
Mailing Address - Phone:509-477-1561
Mailing Address - Fax:
Practice Address - Street 1:3507 S. SPOTTED RD.
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-477-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60697902OtherCDPT LICENSE