Basic Information
| Provider Information | |||||||||
| NPI: | 1700249711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 CUSHING LOT RD | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053544404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022225136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 TOWN CRIER DR | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053018669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022584623 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2016 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.