Provider Demographics
NPI:1487743860
Name:JENKINS, YOLANDA L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:L
Last Name:JENKINS
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 1:2728 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5298
Mailing Address - Country:US
Mailing Address - Phone:706-830-0392
Mailing Address - Fax:706-733-1708
Practice Address - Street 1:2728 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5298
Practice Address - Country:US
Practice Address - Phone:706-830-0392
Practice Address - Fax:706-733-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist