MEDICARE: DEANNA LYNNE JENKINS LICSW

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	CSW008681	GA
2	1041C0700X	Clinical Social Worker	5995	ND
3	1041C0700X	Clinical Social Worker	24095	MN

General Provider Information

NPI Number	:	1659868362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LYNNE JENKINS LICSW

Provider Business Mailing Address
First Line	:	2701 12TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-8753
Country	:	US
Telephone Number	:	701-451-4900
Fax Number	:	651-925-0057

Provider Business Practice Location Address
First Line	:	4324 UNIVERSITY AVE STE B
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-1938
Country	:	US
Telephone Number	:	701-746-4584
Fax Number	:	651-925-0057

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	09/09/2025

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