Mary Phyllis Jensen, CCC-SLP, MS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL00002797 Issued in WA

Practice address

4690 NE North Tolo Rd
Bainbridge Island, WA 98110-1429

Phone

(206) 913-3236

NPI assigned

Dec 19, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387411200000",
    "number": "1205257193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4690 NE NORTH TOLO RD",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101429",
            "telephone_number": "206-913-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4690 NE NORTH TOLO RD",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101429",
            "telephone_number": "206-913-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "MARY",
        "middle_name": "PHYLLIS",
        "credential": "CCC-SLP,  MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-19",
        "last_updated": "2013-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00002797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.