Provider Demographics
NPI:1396163960
Name:JENKINS, SHARON FLUDD (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:FLUDD
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:SPEECH LANGUAGE HEARING CLINIC
Mailing Address - Street 2:SCSU - 300 COLLEGE ST NE
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29117-0001
Mailing Address - Country:US
Mailing Address - Phone:803-536-8589
Mailing Address - Fax:803-536-8357
Practice Address - Street 1:SPEECH LANGUAGE HEARING CLINIC
Practice Address - Street 2:SCSU - 300 COLLEGE ST NE
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29117-0001
Practice Address - Country:US
Practice Address - Phone:803-536-8589
Practice Address - Fax:803-536-8357
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC388231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC349987Medicaid
SC1033288402OtherNPI