Healthcare Provider Details

I. General information

NPI: 1659689396
Provider Name (Legal Business Name): AMY JENKINS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W SOUTHERN AVE
APACHE JUNCTION AZ
85120-7416
US

IV. Provider business mailing address

2979 E MUIRFIELD ST
GILBERT AZ
85298-9063
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1110
  • Fax:
Mailing address:
  • Phone: 480-699-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: