Healthcare Provider Details

I. General information

NPI: 1083986897
Provider Name (Legal Business Name): MS. LINDA JENKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 UNIVERSITY DR SUITE 109
MENLO PARK CA
94025-4408
US

IV. Provider business mailing address

PO BOX 1406
MENLO PARK CA
94026-1406
US

V. Phone/Fax

Practice location:
  • Phone: 650-306-0339
  • Fax:
Mailing address:
  • Phone: 650-306-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC41785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: