Provider Demographics
NPI:1346585478
Name:JENKINS, WENDI B (BCBA)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:B
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 1:336 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1246
Mailing Address - Country:US
Mailing Address - Phone:540-977-1773
Mailing Address - Fax:
Practice Address - Street 1:336 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064-1246
Practice Address - Country:US
Practice Address - Phone:540-977-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst