Provider Demographics
NPI:1033349931
Name:JENKINS-GILLIS, TERRILYNN F
Entity Type:Individual
Prefix:DR
First Name:TERRILYNN
Middle Name:F
Last Name:JENKINS-GILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRILYNN
Other - Middle Name:F
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD,, CCC-SLP
Mailing Address - Street 1:57685 TRUE HOPE LN
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-4541
Mailing Address - Country:US
Mailing Address - Phone:225-687-1775
Mailing Address - Fax:
Practice Address - Street 1:57685 TRUE HOPE LN
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-4541
Practice Address - Country:US
Practice Address - Phone:225-687-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6032235Z00000X
FLSA8715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist