Provider Demographics
NPI:1982240313
Name:JENKINS, KAITLIN JEAN CLEMENTS
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JEAN CLEMENTS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:JEAN
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:COLUMBIA WELLNESS
Mailing Address - Street 2:720 14TH AVE
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-353-9396
Mailing Address - Fax:360-577-0187
Practice Address - Street 1:COLUMBIA WELLNESS
Practice Address - Street 2:720 14TH AVE
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-567-2211
Practice Address - Fax:360-577-0187
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61023510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health