Provider Demographics
NPI:1205283983
Name:JONKERS, BARB
Entity type:Individual
Prefix:MRS
First Name:BARB
Middle Name:
Last Name:JONKERS
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 1:112 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:SD
Mailing Address - Zip Code:57315-2030
Mailing Address - Country:US
Mailing Address - Phone:605-999-1162
Mailing Address - Fax:
Practice Address - Street 1:406 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2280
Practice Address - Country:US
Practice Address - Phone:605-589-3134
Practice Address - Fax:605-589-3661
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD053OtherSD LICENSURE