Provider Demographics
NPI:1720497415
Name:JENKINS, CAITLIN
Entity Type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:
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 1:1870 HORIZON WAY
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5600
Mailing Address - Country:US
Mailing Address - Phone:928-925-9543
Mailing Address - Fax:
Practice Address - Street 1:101 S AIRPARK RD
Practice Address - Street 2:STE. M.
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4182
Practice Address - Country:US
Practice Address - Phone:928-776-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA90302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant