MEDICARE: MS. JUDE JENKINS-SCHRACK BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-15-18221	AK

General Provider Information

NPI Number	:	1093102956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDE JENKINS-SCHRACK BCBA

Provider Business Mailing Address
First Line	:	1076 BADGER RD
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-5047
Country	:	US
Telephone Number	:	702-279-8679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 BADGER RD
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-5047
Country	:	US
Telephone Number	:	702-279-8679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2015
Last Update Date	:	04/18/2015

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