Healthcare Provider Details

I. General information

NPI: 1013910892
Provider Name (Legal Business Name): EMIKO JANE LEJEUNE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMIKO JANE MCGRAW M.S.

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 MEMORIAL DR
CLARKSVILLE TN
37043-4561
US

IV. Provider business mailing address

1740 MEMORIAL DR
CLARKSVILLE TN
37043-4561
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-3937
  • Fax:
Mailing address:
  • Phone: 931-645-3937
  • Fax: 931-645-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0216
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1149
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: