Provider Demographics
NPI:1730530817
Name:J5 THERAPY, INC.
Entity type:Organization
Organization Name:J5 THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:501-247-8366
Mailing Address - Street 1:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-3419
Mailing Address - Country:US
Mailing Address - Phone:501-213-0594
Mailing Address - Fax:844-272-0941
Practice Address - Street 1:2700 N PRICKETT RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7503
Practice Address - Country:US
Practice Address - Phone:501-213-0594
Practice Address - Fax:844-272-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14079625235Z00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR215977742Medicaid