Provider Demographics
NPI:1114703303
Name:JENKINS, JALETHA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JALETHA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N KEYSTONE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2499
Mailing Address - Country:US
Mailing Address - Phone:317-296-5382
Mailing Address - Fax:
Practice Address - Street 1:2004 FREMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3153
Practice Address - Country:US
Practice Address - Phone:317-296-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
IN33900285A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No104100000XBehavioral Health & Social Service ProvidersSocial Worker