Provider Demographics
NPI:1912167321
Name:JENKINS-FAKOLUJO, DONNA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:JENKINS-FAKOLUJO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W SCHOOL HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3404
Mailing Address - Country:US
Mailing Address - Phone:215-951-4701
Mailing Address - Fax:
Practice Address - Street 1:100 W SCHOOL HOUSE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3404
Practice Address - Country:US
Practice Address - Phone:215-951-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist