Provider Demographics
NPI:1568631307
Name:JENKINS, PATRICIA LANG (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LANG
Last Name:JENKINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 FLINT RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6031
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:2506 DANVILLE RD SW
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4232
Practice Address - Country:US
Practice Address - Phone:256-350-6331
Practice Address - Fax:256-350-1990
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSLP2438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917620OtherMEDICAID GROUP
AL1003819608OtherGROUP NPI
ALK531OtherMEDICARE GROUP