Provider Demographics
NPI:1053518563
Name:JENSEN, HEATHER JO (AUD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JO
Last Name:JENSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USU HEARING CLINIC
Mailing Address - Street 2:1000 OLD MAIN HILL
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-1000
Mailing Address - Country:US
Mailing Address - Phone:435-797-1390
Mailing Address - Fax:435-797-0221
Practice Address - Street 1:USU HEARING CLINIC
Practice Address - Street 2:1000 OLD MAIN HILL
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-1000
Practice Address - Country:US
Practice Address - Phone:435-797-1390
Practice Address - Fax:435-797-0221
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308851-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000528062Medicaid