Provider Demographics
NPI:1902954340
Name:JENSEN, DIANA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2030
Mailing Address - Country:US
Mailing Address - Phone:202-686-2885
Mailing Address - Fax:
Practice Address - Street 1:5335 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 440
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2030
Practice Address - Country:US
Practice Address - Phone:202-686-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS00440Medicare UPIN