Provider Demographics
NPI:1154051209
Name:JASSO, CHANELLE KRISTEN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHANELLE
Middle Name:KRISTEN
Last Name:JASSO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13248 SPRUCE RUN DR APT 205
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-7482
Mailing Address - Country:US
Mailing Address - Phone:480-202-8742
Mailing Address - Fax:
Practice Address - Street 1:90 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1951
Practice Address - Country:US
Practice Address - Phone:234-571-9110
Practice Address - Fax:234-571-9107
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist