Provider Demographics
NPI:1952149783
Name:SCHRECENGOST, JAYKE
Entity type:Individual
Prefix:
First Name:JAYKE
Middle Name:
Last Name:SCHRECENGOST
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:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-0966
Mailing Address - Country:US
Mailing Address - Phone:928-855-6333
Mailing Address - Fax:
Practice Address - Street 1:145 LAKE HAVASU AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5616
Practice Address - Country:US
Practice Address - Phone:928-855-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker