Most Relevant Information
Provider Data
| NPI Number: | 1003591033 |
| Provider Name: | TRISTA MARIE JENSEN MPA, BA-SOCIAL WORK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/19/2023 |
| Last Updated: | 06/19/2023 |
Provider Practice Location
526 RAVEN WAY APT A
CHUBBUCK
ID
832021926
Practice Location Phone/Fax
| Phone: | 2083800978 |
| Fax: |
Provider Mailing Location
526 RAVEN WAY APT A
CHUBBUCK
ID
832021926
Provider Mailing Phone/Fax
| Phone: | 2083800978 |
| Fax: |