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NPI Code Detail

MEDICARE: NICHOLAS JENKINS

MEDICARE: NICHOLAS 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
1101YM0800XMental Health Counselor6638-125WI

General Provider Information

NPI Number : 1942793070
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS JENKINS
Provider Business Mailing Address
First Line : 2439 S WENTWORTH AVE APT A
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-1932
Country : US
Telephone Number : 847-476-2195
Fax Number :
Provider Business Practice Location Address
First Line : 2439 S WENTWORTH AVE APT A
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-1932
Country : US
Telephone Number : 847-476-2195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2018
Last Update Date : 06/13/2018

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Directions to “ NICHOLAS JENKINS ” Practice Location

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