Healthcare Provider Details

I. General information

NPI: 1073150108
Provider Name (Legal Business Name): SALENA MARIE JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 10/02/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 S. WISCONSIN AVE.
GAYLORD MI
49735
US

IV. Provider business mailing address

4414 M 65
OSCODA MI
48750-9229
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0360
  • Fax:
Mailing address:
  • Phone: 517-458-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: