Provider Demographics
NPI:1679738777
Name:JENKINS, VIRGINIA NAOMI (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:NAOMI
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14906 SIERRA SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4262
Mailing Address - Country:US
Mailing Address - Phone:832-233-8204
Mailing Address - Fax:281-459-6239
Practice Address - Street 1:14906 SIERRA SUNSET DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4262
Practice Address - Country:US
Practice Address - Phone:832-233-8204
Practice Address - Fax:281-459-6239
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist