Provider Demographics
NPI:1891825592
Name:JENKINS, KAREN L
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-1960
Mailing Address - Country:US
Mailing Address - Phone:573-365-7111
Mailing Address - Fax:573-365-5748
Practice Address - Street 1:1571 BAGNELL DAM BLVD.
Practice Address - Street 2:BOX 1960,
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049
Practice Address - Country:US
Practice Address - Phone:573-365-7111
Practice Address - Fax:573-365-5748
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLIFETIME235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist