Provider Demographics
NPI:1316234727
Name:JENKINSON, SANDRA B (CGC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:JENKINSON
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:B
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CGC
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1440 E COUNTY LINE RD STE 3200
Practice Address - Street 2:SUITE 3200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-621-9254
Practice Address - Fax:317-957-2712
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300008011Medicaid