Provider Demographics
NPI:1235550831
Name:JENKINS, CHAELAH (BCBA)
Entity Type:Individual
Prefix:
First Name:CHAELAH
Middle Name:
Last Name:JENKINS
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 1:1702 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1281
Mailing Address - Country:US
Mailing Address - Phone:816-517-7476
Mailing Address - Fax:
Practice Address - Street 1:1702 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1281
Practice Address - Country:US
Practice Address - Phone:816-517-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013034377103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst