Healthcare Provider Details

I. General information

NPI: 1235071960
Provider Name (Legal Business Name): JENNIFER MARIE JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

IV. Provider business mailing address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-1607
  • Fax: 406-395-4399
Mailing address:
  • Phone: 406-395-1607
  • Fax: 406-395-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number70993
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: