Healthcare Provider Details

I. General information

NPI: 1013526243
Provider Name (Legal Business Name): KAYLA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 FIR ST UNIT 216
EAST CHICAGO IN
46312
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-392-7498
  • Fax: 219-703-6912
Mailing address:
  • Phone: 219-392-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011401A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33009711A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: