Provider Demographics
NPI:1063804268
Name:JENKINS, SARAH (SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 WILSON MILLS RD
Mailing Address - Street 2:#126
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3016
Mailing Address - Country:US
Mailing Address - Phone:216-223-8761
Mailing Address - Fax:309-423-4813
Practice Address - Street 1:5247 WILSON MILLS RD
Practice Address - Street 2:#126
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3016
Practice Address - Country:US
Practice Address - Phone:216-223-8761
Practice Address - Fax:309-423-4813
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-11073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist