Provider Demographics
NPI:1972775187
Name:JENKINS, DENA MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5124
Mailing Address - Country:US
Mailing Address - Phone:479-478-6486
Mailing Address - Fax:
Practice Address - Street 1:8113 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5124
Practice Address - Country:US
Practice Address - Phone:479-650-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist