Provider Demographics
NPI:1376805200
Name:JASSEM, HARRIET (MS)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:
Last Name:JASSEM
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 1:97 ENCANTADO LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8278
Mailing Address - Country:US
Mailing Address - Phone:505-690-4512
Mailing Address - Fax:
Practice Address - Street 1:97 ENCANTADO LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8278
Practice Address - Country:US
Practice Address - Phone:505-690-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist