Healthcare Provider Details

I. General information

NPI: 1578605515
Provider Name (Legal Business Name): DANA ALLISON JENKINS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 STILLER RD
STEELVILLE MO
65565-4553
US

IV. Provider business mailing address

9 STILLER RD
STEELVILLE MO
65565-4553
US

V. Phone/Fax

Practice location:
  • Phone: 573-775-3326
  • Fax:
Mailing address:
  • Phone: 573-775-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number101930
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: