Provider Demographics
NPI:1659868362
Name:JENKINS, DEANNA LYNNE (LICSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNNE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:OLSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9859
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58106-9859
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:651-925-0057
Practice Address - Street 1:1726 S WASHINGTON ST STE 33A
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6395
Practice Address - Country:US
Practice Address - Phone:701-746-4584
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN240951041C0700X
ND59951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical