Provider Demographics
NPI:1871668038
Name:JENKINS, JESSICA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEE
Last Name:JENKINS
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:20300 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4169
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:248-559-8776
Practice Address - Street 1:200 DIVERSON ST
Practice Address - Street 2:SUITE 10 A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2273
Practice Address - Country:US
Practice Address - Phone:248-608-9740
Practice Address - Fax:248-608-9752
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIPERMID6301013418L982103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist