Provider Demographics
NPI:1942870001
Name:STEPHEN JENKINS PHD ABPP LP PLLC
Entity Type:Organization
Organization Name:STEPHEN JENKINS PHD ABPP LP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:320-253-3715
Mailing Address - Street 1:1741 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9164
Mailing Address - Country:US
Mailing Address - Phone:320-309-8784
Mailing Address - Fax:
Practice Address - Street 1:1411 W SAINT GERMAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4180
Practice Address - Country:US
Practice Address - Phone:320-253-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty