MEDICARE: MELANIE JENKINS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-21-11742	NJ
2	106S00000X	Behavior Technician	RBT-19-80393	NJ
3	103K00000X	Behavior Analyst	1-23-68636	NC

General Provider Information

NPI Number	:	1396305959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE JENKINS BCBA

Provider Business Mailing Address
First Line	:	3317 MASONBORO LOOP RD UNIT 150
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-2970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 MASONBORO LOOP RD UNIT 150
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-2970
Country	:	US
Telephone Number	:	910-599-2230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	10/10/2023

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