Wanda Ethel Jensen, LCSW
Individual provider Active NPI Clinical Social Worker · Lima, MT
NPI 1154099588 · NPPES record last updated Mar 19, 2025
Key facts
- NPI
- 1154099588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 62696 (MT)
- Practice address
- 120 W 3Rd Ave
Lima, MT 59739 - Phone
- (406) 660-0904
- NPI assigned
- Aug 31, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231205001376 | MT | Practitioner - Clinical Social Worker | 3678921459 | Practice locations: Lima, MT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37100 | MT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 62696 | MT | Yes |
| Clinical Social Worker | 1041C0700X | 37100 | MT |
Addresses
Primary practice location
120 W 3Rd Ave
Lima, MT 59739
Mailing address
PO Box 13
Lima, MT 59739-0013
Phone (406) 660-0904
Other providers in Lima, MT
All providers in Lima, MT · Clinical Social Worker in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.