Provider Demographics
NPI:1003494824
Name:ENOCKSON, JASMIN DENAE (MS SLP)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:DENAE
Last Name:ENOCKSON
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:DENAE
Other - Last Name:PAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-1731
Mailing Address - Country:US
Mailing Address - Phone:701-629-6949
Mailing Address - Fax:
Practice Address - Street 1:45 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763
Practice Address - Country:US
Practice Address - Phone:701-629-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist