Provider Demographics
NPI:1679732853
Name:SENK, JEFFREY ALLEN (LLMSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:SENK
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:N9937 EAST SHORE ROAD
Mailing Address - Street 2:PO BOX 137
Mailing Address - City:MARENISCO
Mailing Address - State:MI
Mailing Address - Zip Code:49947
Mailing Address - Country:US
Mailing Address - Phone:906-229-6135
Mailing Address - Fax:906-229-6191
Practice Address - Street 1:103 W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-9515
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:906-229-6191
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI200897101YA0400X
MI6801090229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090229OtherLICENSE NUMBER