Gerald Edward Jensen Jr., MA, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4642 Issued in MN

Practice address

2155 Antler Dr SW
Brainerd, MN 56401-2589

Phone

(218) 822-3736

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jerry E Jensen Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cedarbrook Community Services

  • Cognitive & Behavioral Psychologist
  • Baxter, MN
  • NPI 1164488847
  NPD (past) Authorized official
• Gerald E. Jensen, Jr.

  • Psychologist
  • Baxter, MN
  • NPI 1871596585
  NPD (past)

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1265435937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2633",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564252633",
            "telephone_number": "218-822-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 ANTLER DR SW",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012589",
            "telephone_number": "218-822-3736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6980 Fairview Rd",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Baxter",
            "state": "MN",
            "postal_code": "564257836",
            "country_code": "US",
            "telephone_number": "218-822-3736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "GERALD",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MA, LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN PSYCHOLOGY LICENSE",
            "identifier": "LP4642",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERRY",
            "last_name": "JENSEN",
            "middle_name": "E",
            "credential": "MA, LP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Andrew Miller Jacobson, M.D.
• Mark A. James, M.D.
• Andrew Michael Janke, AUD
• Nathan Anton Jarnot, DDS
• Jennifer Owens Therapy Services, LLC
• Lana Jayne Jensen, OTR/L
• Tracy Jan Jeremiason, MSW, LICSW
• Stephen Dion Jobe, DC
• Tegan Nicole John, D.O.
• Daniel Verdon Johnson, M.D.

• Psychologist in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; 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.