Healthcare Provider Details

I. General information

NPI: 1003310210
Provider Name (Legal Business Name): RENEE ANN JENKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E SUNSHINE ST
SPRINGFIELD MO
65804-1214
US

IV. Provider business mailing address

1550 E SUNSHINE ST
SPRINGFIELD MO
65804-1214
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-7500
  • Fax:
Mailing address:
  • Phone: 417-883-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010009745
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: