Provider Demographics
NPI:1689708653
Name:JENKINS, JENNIFER (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PALMETTO AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1391
Mailing Address - Country:US
Mailing Address - Phone:650-290-0326
Mailing Address - Fax:707-526-9672
Practice Address - Street 1:429 SPEERS RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3123
Practice Address - Country:US
Practice Address - Phone:707-571-2215
Practice Address - Fax:707-526-9672
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist