Provider Demographics
NPI:1013398015
Name:NORMAN, JASMINE PATRICIA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:PATRICIA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 GODFROY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2724
Mailing Address - Country:US
Mailing Address - Phone:410-818-7088
Mailing Address - Fax:
Practice Address - Street 1:38807 ANN ARBOR RD STE 3
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3896
Practice Address - Country:US
Practice Address - Phone:734-474-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI11939851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician