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NPI Code Detail

MEDICARE: MARIE JENKINS BA SOCIOLOGY

MEDICARE: MARIE JENKINS BA SOCIOLOGY
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1538660238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE JENKINS BA SOCIOLOGY
Provider Business Mailing Address
First Line : PO BOX 190
Second Line :
City : ST STEPHENS
State : WY
Zip : 82524-0190
Country : US
Telephone Number : 307-856-0470
Fax Number :
Provider Business Practice Location Address
First Line : 24 GREAT PLAINS ROAD
Second Line :
City : ARAPAHO
State : WY
Zip : 82510-9144
Country : US
Telephone Number : 307-856-0470
Fax Number : 307-857-4383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2018
Last Update Date : 02/27/2018

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