Provider Demographics
NPI:1730776725
Name:JENSEN, BAILEY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18612 70TH LN NE APT 109
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2152
Mailing Address - Country:US
Mailing Address - Phone:402-813-1663
Mailing Address - Fax:
Practice Address - Street 1:18612 70TH LN NE APT 109
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2152
Practice Address - Country:US
Practice Address - Phone:402-813-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610956141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical