Provider Demographics
NPI:1083027486
Name:JENKINS, MARTHA JANE (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N GRAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2096
Mailing Address - Country:US
Mailing Address - Phone:754-227-9480
Mailing Address - Fax:
Practice Address - Street 1:330 N GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2096
Practice Address - Country:US
Practice Address - Phone:754-227-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61144443103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist