Provider Demographics
NPI:1427671403
Name:DANIELLE D JENKINS PLLC
Entity type:Organization
Organization Name:DANIELLE D JENKINS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-339-4079
Mailing Address - Street 1:4007 BRIDGEPORT WAY W STE A
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4330
Mailing Address - Country:US
Mailing Address - Phone:360-339-4079
Mailing Address - Fax:
Practice Address - Street 1:324 WEST BAY DRIVE NW
Practice Address - Street 2:SUITE 218
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9850
Practice Address - Country:US
Practice Address - Phone:360-339-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457723504OtherNPI