Provider Demographics
NPI:1699937516
Name:JENKINS, SUZANNE RENEE (RRT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 W 500 S
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2980
Mailing Address - Country:US
Mailing Address - Phone:435-843-7756
Mailing Address - Fax:
Practice Address - Street 1:952 W 500 S
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2980
Practice Address - Country:US
Practice Address - Phone:435-843-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5816001-5701227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered