Provider Demographics
NPI:1306925359
Name:JENKINS, SANDRA LYNN
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5211
Mailing Address - Country:US
Mailing Address - Phone:907-762-2847
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5211
Practice Address - Country:US
Practice Address - Phone:907-762-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health