Provider Demographics
NPI:1740698489
Name:JENKS, DEBORAH (LAT)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:JENKS
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1226
Mailing Address - Country:US
Mailing Address - Phone:608-692-7912
Mailing Address - Fax:
Practice Address - Street 1:2501 W BELTLINE HWY
Practice Address - Street 2:SUITE 601
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2318
Practice Address - Country:US
Practice Address - Phone:608-288-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI405-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer