Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 559 | SD |
Y | 103TC0700X | Clinical Psychologist | 559 | SD |
N | 103G00000X | Clinical Psychologist | PY6897 | FL |
N | 103TC0700X | Clinical Psychologist | PY6897 | FL |
N | 103G00000X | Clinical Psychologist | WY530 | WY |
N | 103TC0700X | Clinical Psychologist | WY530 | WY |
NPI | 1003975467 |
---|---|
Provider Name | Sandra Jensen |
First Address | Rapid City, SD 57702-6817 |
Second Address | Rapid City, SD 57702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 04/07/2019 |