Provider Demographics
NPI:1316576036
Name:RENE, JASMINE PHYLICIA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:PHYLICIA
Last Name:RENE
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 1:6515 BELCREST RD # 1104-A
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2010
Mailing Address - Country:US
Mailing Address - Phone:323-514-5945
Mailing Address - Fax:
Practice Address - Street 1:6515 BELCREST RD # 1104-A
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2010
Practice Address - Country:US
Practice Address - Phone:323-514-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist