Provider Demographics
NPI:1558690669
Name:JENKINS, MARLENA L (BA,, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:BA,, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 GOVERNORS DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2514
Mailing Address - Country:US
Mailing Address - Phone:904-651-5485
Mailing Address - Fax:
Practice Address - Street 1:12205 GOVERNORS DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2514
Practice Address - Country:US
Practice Address - Phone:904-651-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst