Provider Demographics
NPI:1063022960
Name:COLLINS, JENNA MICHELLE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 E SPRINGFIELD AVE STE H
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2954
Mailing Address - Country:US
Mailing Address - Phone:509-999-5657
Mailing Address - Fax:
Practice Address - Street 1:1910 S STAPLEY DR STE 119
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6675
Practice Address - Country:US
Practice Address - Phone:623-263-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-23-63981103K00000X
106S00000X
AZBEH-001058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician