Provider Demographics
NPI:1194158204
Name:ELIZABETH JENKINS
Entity type:Organization
Organization Name:ELIZABETH JENKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-661-5380
Mailing Address - Street 1:404 COFFEE LN
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-6612
Mailing Address - Country:US
Mailing Address - Phone:865-661-5380
Mailing Address - Fax:865-285-9411
Practice Address - Street 1:127 S KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2746
Practice Address - Country:US
Practice Address - Phone:865-705-8688
Practice Address - Fax:865-285-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1194158204OtherTN CARE, UNITED HEALTH CARE