Provider Demographics
NPI:1841676137
Name:JENKINS, LESLIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 GREENEWAY COMMONS PL STE 203
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4065
Mailing Address - Country:US
Mailing Address - Phone:502-822-6623
Mailing Address - Fax:502-996-8260
Practice Address - Street 1:8910 GREENEWAY COMMONS PL STE 203
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4065
Practice Address - Country:US
Practice Address - Phone:502-822-6623
Practice Address - Fax:502-996-8260
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167007103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100375930Medicaid