Provider Demographics
NPI:1487894143
Name:JENSEN, SCOTT A (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Mailing Address - Street 2:3601 PACIFIC AVE.
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211-0001
Mailing Address - Country:US
Mailing Address - Phone:209-946-7320
Mailing Address - Fax:209-946-2454
Practice Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Practice Address - Street 2:3601 PACIFIC AVE.
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0001
Practice Address - Country:US
Practice Address - Phone:209-946-7320
Practice Address - Fax:209-946-2454
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21860103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent