Provider Demographics
NPI:1194453241
Name:KING, JENA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 TAWAKONI DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-4251
Mailing Address - Country:US
Mailing Address - Phone:859-801-9917
Mailing Address - Fax:
Practice Address - Street 1:16301 ELEMENTARY DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-5785
Practice Address - Country:US
Practice Address - Phone:817-698-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist