Healthcare Provider Details

I. General information

NPI: 1952536120
Provider Name (Legal Business Name): MELISSA LEEANN JENKINS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W 8TH ST STE 103
LAWRENCE KS
66044-2676
US

IV. Provider business mailing address

123 W 8TH ST STE 103
LAWRENCE KS
66044-2676
US

V. Phone/Fax

Practice location:
  • Phone: 785-835-3020
  • Fax: 207-419-7483
Mailing address:
  • Phone: 785-835-5020
  • Fax: 207-419-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number503
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: