Healthcare Provider Details

I. General information

NPI: 1710733886
Provider Name (Legal Business Name): JONAS JENKINS MS, CCC-SLP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7431 SE 302ND AVE
GRESHAM OR
97080-8855
US

IV. Provider business mailing address

5286 NE 60TH AVE
PORTLAND OR
97218-3004
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-4818
  • Fax:
Mailing address:
  • Phone: 503-841-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013267
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: