MEDICARE: VICTORIA JOY JENKINS

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	106S00000X	Behavior Technician	RBT-19-97611	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629608898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA JOY JENKINS

Provider Business Mailing Address
First Line	:	5526 N ACADEMY BLVD STE 109
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3688
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 OAK HILLS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3480
Country	:	US
Telephone Number	:	571-244-9552
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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