1295014199 NPI number — ELIZABETH A JENSEMA LCSW

Table of content: ELIZABETH A JENSEMA LCSW (NPI 1295014199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295014199 NPI number — ELIZABETH A JENSEMA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEMA
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FICHTNER
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295014199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W2228 KOENE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEBOYGAN FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53085-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-980-2183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W2228 KOENE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEBOYGAN FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53085-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-980-2183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  8522123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295014199 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295014199 . This is a "BCBS MN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com