Provider Demographics
NPI:1316184013
Name:JENKINS, NICOLE ALEXANDRIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXANDRIA
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 1:6835 E HEARN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3414
Mailing Address - Country:US
Mailing Address - Phone:520-405-4999
Mailing Address - Fax:
Practice Address - Street 1:4800 E DOUBLETREE RANCH RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1524
Practice Address - Country:US
Practice Address - Phone:520-405-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6039235Z00000X
AZSLP6039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist