Provider Demographics
NPI:1215978218
Name:JENKINS, IVA ELIZABETH (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:IVA ELIZABETH
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:MS
Other - First Name:IVA
Other - Middle Name:ELIZABETH
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1966
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457
Mailing Address - Country:US
Mailing Address - Phone:843-224-9565
Mailing Address - Fax:
Practice Address - Street 1:9225 UNIVERSITY BLVD
Practice Address - Street 2:STE D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-569-4546
Practice Address - Fax:843-569-4535
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist