Provider Demographics
NPI:1700927183
Name:JENKINS, LEANN (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:LEANN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 N MULFORD RD STE 11
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5165
Mailing Address - Country:US
Mailing Address - Phone:815-399-1950
Mailing Address - Fax:815-399-1959
Practice Address - Street 1:461 N MULFORD RD STE 11
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5165
Practice Address - Country:US
Practice Address - Phone:815-399-1950
Practice Address - Fax:815-399-1959
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132174Medicare UPIN