Provider Demographics
NPI:1952613739
Name:JENKINS, JEFFREY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8624
Mailing Address - Country:US
Mailing Address - Phone:740-532-1512
Mailing Address - Fax:
Practice Address - Street 1:558 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-8624
Practice Address - Country:US
Practice Address - Phone:740-532-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical