MEDICARE: AMANDA JENKINS LCSW

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	1041C0700X	Clinical Social Worker	10378435-3502	UT

General Provider Information

NPI Number	:	1457706301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JENKINS LCSW

Provider Business Mailing Address
First Line	:	3724 LAKESIDE DR STE 200
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-5293
Country	:	US
Telephone Number	:	775-895-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3724 LAKESIDE DR STE 200
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-5293
Country	:	US
Telephone Number	:	775-895-0712
Fax Number	:

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	08/01/2025

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