Healthcare Provider Details

I. General information

NPI: 1972153716
Provider Name (Legal Business Name): REBEKAH JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHURCHMANS RD STE 100A
NEWARK DE
19702-1943
US

IV. Provider business mailing address

1345 ENTERPRISE DR
WEST CHESTER PA
19380-5964
US

V. Phone/Fax

Practice location:
  • Phone: 302-544-5055
  • Fax:
Mailing address:
  • Phone: 484-787-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: