Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW.09924189 | CO |
NPI | 1003261330 |
---|---|
Provider Name | Temry Jenks |
First Address | Elizabeth, CO 80107-8593 |
Second Address | Elizabeth, CO 80107-8593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2016 |
Last Update Date | 10/08/2021 |