Provider Demographics
NPI:1497398598
Name:PANNGASIRI, JASMINE CARBAJAL
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CARBAJAL
Last Name:PANNGASIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:CARBAJAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17200 WESTGROVE DR APT 1521
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7130
Mailing Address - Country:US
Mailing Address - Phone:915-493-4254
Mailing Address - Fax:
Practice Address - Street 1:3600 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4212
Practice Address - Country:US
Practice Address - Phone:915-493-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist