Jenkins, Modena

Jenkins, Modena is an sole proprietor health care provider with primary practice located at 434 N Ohio Ave , Wichita KS 67214-3938. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Jenkins, Modena can be contacted via phone (316) 409-6626.

Contact Information

Primary practice address
434 N Ohio Ave Wichita KS 67214-3938
Phone: (316) 409-6626
Fax: (316) 776-4479
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 9524 Kansas
Behavioral Health & Social Service Providers / Clinical 1041C0700X 05401 Kansas

Profile Details

NPI number 1023489275
LBN Legal business name Jenkins, Modena
Credentials LSCSW
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 14th, 2015
Last updated Apr 29th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023489275 NPPES
Kansas MEDICAID 201121550B

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