Active NPI
Jessica Lee Jenkins, PHD
- Psychologist
- Rochester Hills, MI
National Provider Identifier
1871668038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PERMID6301013418L982
- Practice address
- 200 Diverson St
Suite 10 a
Rochester Hills, MI 48307-2273 - Phone
- (248) 608-9740
- Fax
- (248) 608-9752
- NPI assigned
- Nov 22, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PERMID6301013418L982 | MI | Primary |
Addresses
Primary practice location
200 Diverson St
Suite 10 a
Rochester Hills, MI 48307-2273
Mailing address
20300 Civic Center Dr
Suite 303
Southfield, MI 48076-4169
Phone (248) 559-8190
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PERMID6301013418L982 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-Care PC | Past | Accepting new patients | |
| Tri Care PC | Psychologist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Farmington Hills, MI
- NPI 1588731756
-
- Community/Behavioral Health Agency
- Farmington Hills, MI
- NPI 1083873103
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871668038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20300 CIVIC CENTER DR",
"address_2": "SUITE 303",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480764169",
"telephone_number": "248-559-8190",
"fax_number": "248-559-8776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 DIVERSON ST",
"address_2": "SUITE 10 A",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483072273",
"telephone_number": "248-608-9740",
"fax_number": "248-608-9752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "JESSICA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "PERMID6301013418L982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.