Healthcare Provider Details

I. General information

NPI: 1477534162
Provider Name (Legal Business Name): KIMBERLY CLIFT JENKINS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KIMBERLY BETH CLIFT M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SOUTH STADIUM HALL
KNOXVILLE TN
37996-0001
US

IV. Provider business mailing address

U.T. HEARING AND SPEECH CENTER 1600 PEYTON MANNING PASS
KNOXVILLE TN
37996-0001
US

V. Phone/Fax

Practice location:
  • Phone: 865-974-1788
  • Fax: 865-974-1539
Mailing address:
  • Phone: 865-974-5451
  • Fax: 865-974-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0000003282
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: