Provider Demographics
NPI:1346809175
Name:JENKINS, SONIA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:MARIE
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 1:140 DROULLIARD AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3698
Mailing Address - Country:US
Mailing Address - Phone:435-764-4941
Mailing Address - Fax:
Practice Address - Street 1:140 DROULLIARD AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3698
Practice Address - Country:US
Practice Address - Phone:435-764-4941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-6626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist