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Individual

MODENA JENKINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LSCSW

Contact information

Practice address
434 N OHIO AVE, WICHITA, KS 67214-3938
(316) 409-6626
(316) 776-4479
Mailing address
434 N OHIO AVE, WICHITA, KS 67214-3938
(316) 409-6626
(316) 776-4479

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
9524
KS
1041C0700X
Clinical Social Worker
Primary
05401
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201121550B
KS
Enumeration date
10/14/2015
Last updated
04/29/2021
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