Provider Demographics
NPI:1124570668
Name:JENKINS, JAQUELINE LEBARON (MS)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:LEBARON
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:JAQUELINE
Other - Middle Name:LEBARON
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16334 N 73RD LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-1806
Mailing Address - Country:US
Mailing Address - Phone:602-576-5779
Mailing Address - Fax:
Practice Address - Street 1:4602 W SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-896-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP10078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist