MEDICARE: MS. MICHEL'LE SHANNE JENKINS M.ED

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	171W00000X	Contractor	OH3200338	OH
2	101YM0800X	Mental Health Counselor		OH

General Provider Information

NPI Number	:	1720762578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHEL'LE SHANNE JENKINS M.ED

Provider Business Mailing Address
First Line	:	201 RIVERSIDE DR STE 2A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-4956
Country	:	US
Telephone Number	:	937-853-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 RIVERSIDE DR STE 2A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-4956
Country	:	US
Telephone Number	:	937-853-8333
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	01/02/2026

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