Individual
MACIE LAINE JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
851 PROFESSIONAL PARK DR, CLARKSVILLE, TN 37040-5257
(931) 542-2168
Mailing address
851 PROFESSIONAL PARK DR, CLARKSVILLE, TN 37040-5257
(931) 542-2168
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-42429
TN
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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