Basic Information
| Provider Information | |||||||||
| NPI: | 1255966453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11116 W 76TH TER APT 1615 | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662141292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146918119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8333 E BLUE PKWY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641334750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164747677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2020 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 3112 | KS | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 2021046503 | MO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.