Provider Demographics
NPI:1457859423
Name:JASIOTA, WILLIAM LANCE (MS SLP CCC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LANCE
Last Name:JASIOTA
Suffix:
Gender:M
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 OAKTON LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7265
Mailing Address - Country:US
Mailing Address - Phone:814-657-1162
Mailing Address - Fax:
Practice Address - Street 1:5330 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7831
Practice Address - Country:US
Practice Address - Phone:410-782-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist