Individual
MRS. PAMELA JEAN JENKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.A.D.C.III
Contact information
Practice address
4811 S 76TH ST, SUITE208, GREENFIELD, WI 53220-4364
(141) 481-7044
(141) 481-7044
Mailing address
311 E EVANDALE DR, OAK CREEK, WI 53154-3015
(141) 476-8031
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
684
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39356400
—
WI
Enumeration date
10/29/2006
Last updated
07/08/2007
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