Provider Demographics
NPI:1790375590
Name:DAWN JENKINS LMSW
Entity Type:Organization
Organization Name:DAWN JENKINS LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-901-5356
Mailing Address - Street 1:1540 PONTIAC RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3339
Mailing Address - Country:US
Mailing Address - Phone:616-901-5356
Mailing Address - Fax:
Practice Address - Street 1:3282 CLEAR VISTA CT NE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9766
Practice Address - Country:US
Practice Address - Phone:616-901-5356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health