Provider Demographics
NPI:1144034851
Name:JENKINS, MACKINZE JUNE (LMT)
Entity type:Individual
Prefix:MS
First Name:MACKINZE
Middle Name:JUNE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19625 E WELLESLEY AVE TRLR 34
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99027-8623
Mailing Address - Country:US
Mailing Address - Phone:509-342-9946
Mailing Address - Fax:
Practice Address - Street 1:19625 E WELLESLEY AVE TRLR 34
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99027-8623
Practice Address - Country:US
Practice Address - Phone:509-342-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61608549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist