Provider Demographics
NPI:1194999730
Name:JENKINS, DEBRA L (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CREEKSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4882
Mailing Address - Country:US
Mailing Address - Phone:509-575-1000
Mailing Address - Fax:
Practice Address - Street 1:3800 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2715
Practice Address - Country:US
Practice Address - Phone:509-248-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist