Maria G Jensen, RN, ICADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

10256980 Issued in ID

Practice address

2975 Overland Ave
Burley, ID 83318-3231

Phone

(208) 878-2600

Fax

(208) 878-1336

NPI assigned

Feb 11, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1245408400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183231",
            "telephone_number": "208-878-2600",
            "fax_number": "208-878-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183231",
            "telephone_number": "208-878-2600",
            "fax_number": "208-878-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "MARIA",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "RN, ICADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "N-15573",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "10256980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010028634",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ihc Health Services, Inc.
• Independent Growth
• Intermountain Medical Group Denver, LLC
• Christian Jackson
• Duane Jeffers, MD
• William F Jensen, MBA, ICADC
• Melvin Terry Jeppson, M.D.
• Alicia Johnson
• Brian Johnson, PA-C
• Evan Johnson, PA-C

• Addiction (Substance Use Disorder) Counselor in Burley, ID
• Providers in Burley, ID by specialty
• Addiction (Substance Use Disorder) Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.