Provider Demographics
NPI:1396188496
Name:GREEN, JASMINE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LANCHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6834
Mailing Address - Country:US
Mailing Address - Phone:803-465-4331
Mailing Address - Fax:
Practice Address - Street 1:113 LANCHIRE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6834
Practice Address - Country:US
Practice Address - Phone:803-465-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist