Provider Demographics
NPI:1346023421
Name:JENKINS, JACQUELYN IMAN
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:IMAN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LATHAM PARK
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3149
Mailing Address - Country:US
Mailing Address - Phone:267-372-4212
Mailing Address - Fax:
Practice Address - Street 1:21 LATHAM PARK
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3149
Practice Address - Country:US
Practice Address - Phone:267-372-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool