Provider Demographics
NPI:1720675549
Name:JENKINS, ANNA CLARE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CLARE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39525 W 14 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1635
Mailing Address - Country:US
Mailing Address - Phone:248-417-4237
Mailing Address - Fax:855-605-9471
Practice Address - Street 1:39525 W 14 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1635
Practice Address - Country:US
Practice Address - Phone:248-417-4237
Practice Address - Fax:855-605-9471
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
MI7401001291103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician