Provider Demographics
NPI:1093102956
Name:JENKINS-SCHRACK, JUDE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JUDE
Middle Name:
Last Name:JENKINS-SCHRACK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 BADGER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5047
Mailing Address - Country:US
Mailing Address - Phone:702-279-8679
Mailing Address - Fax:
Practice Address - Street 1:1076 BADGER RD
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5047
Practice Address - Country:US
Practice Address - Phone:702-279-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1-15-18221103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst