Provider Demographics
NPI:1952611964
Name:JENKINS WILSON, JESSICA JENKINS (MSC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JENKINS
Last Name:JENKINS WILSON
Suffix:
Gender:F
Credentials:MSC INTERN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:MERRILL
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC INTERN
Mailing Address - Street 1:370 S 500 E STE 135
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-4001
Mailing Address - Country:US
Mailing Address - Phone:801-815-3443
Mailing Address - Fax:801-495-2076
Practice Address - Street 1:195 E 840 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5016
Practice Address - Country:US
Practice Address - Phone:801-310-9692
Practice Address - Fax:801-225-7053
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness