Provider Demographics
NPI:1588902548
Name:JENSCH, KRISTINE MARIE (CAC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:JENSCH
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-9577
Mailing Address - Country:US
Mailing Address - Phone:715-209-1485
Mailing Address - Fax:
Practice Address - Street 1:502 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1554
Practice Address - Country:US
Practice Address - Phone:715-209-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist