Provider Demographics
NPI:1013910892
Name:LEJEUNE, EMIKO JANE (MS)
Entity type:Individual
Prefix:
First Name:EMIKO
Middle Name:JANE
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EMIKO
Other - Middle Name:JANE
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1740 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4561
Mailing Address - Country:US
Mailing Address - Phone:931-645-3937
Mailing Address - Fax:931-645-1043
Practice Address - Street 1:1740 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4561
Practice Address - Country:US
Practice Address - Phone:931-645-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0216231H00000X
TN1149231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3192569Medicaid
TN5310751OtherAETNA HEALTHCARE
TN110-3973866002OtherCIGNA
TN4035629OtherBLUE CROSS/ BLUE SHIELD
TN9376162OtherPHCS
TN3192569Medicare ID - Type Unspecified