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NPI Code Detail

MEDICARE: RANDALL JENKS PH.D. CCC-SLP

MEDICARE: RANDALL JENKS PH.D. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist12496CA

General Provider Information

NPI Number : 1164845376
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL JENKS PH.D. CCC-SLP
Provider Business Mailing Address
First Line : 28202 CABOT RD STE 300
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-1249
Country : US
Telephone Number : 949-365-5858
Fax Number :
Provider Business Practice Location Address
First Line : 28202 CABOT RD STE 300
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-1249
Country : US
Telephone Number : 949-365-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2014
Last Update Date : 01/23/2014

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Directions to “ RANDALL JENKS PH.D. CCC-SLP” Practice Location

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