Active NPI
Melissa Ann Jenks, LPC
- Professional Counselor
- Milwaukee, WI
National Provider Identifier
1316229636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4554-125
- Practice address
- 620 S 76TH St
Suite 120
Milwaukee, WI 53214-1599 - Phone
- (414) 453-1400
- Fax
- (414) 453-2538
- NPI assigned
- Sep 13, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4554-125 | WI | Primary |
Addresses
Primary practice location
620 S 76TH St
Suite 120
Milwaukee, WI 53214-1599
Mailing address
620 S 76TH St
Suite 120
Milwaukee, WI 53214-1599
Phone (414) 453-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316229636 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4554-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421020800000",
"number": "1316229636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 S 76TH ST",
"address_2": "SUITE 120",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532141599",
"telephone_number": "414-453-1400",
"fax_number": "414-453-2538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 S 76TH ST",
"address_2": "SUITE 120",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532141599",
"telephone_number": "414-453-1400",
"fax_number": "414-453-2538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKS",
"first_name": "MELISSA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-13",
"last_updated": "2015-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "4554-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1316229636",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.