Provider Demographics
NPI:1497491922
Name:HOUSTON, JAZMIN NICOLE LISENA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:NICOLE LISENA
Last Name:HOUSTON
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 1:2504 S ALAFAYA TRL STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7977
Mailing Address - Country:US
Mailing Address - Phone:407-249-3344
Mailing Address - Fax:
Practice Address - Street 1:2504 S ALAFAYA TRL STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7977
Practice Address - Country:US
Practice Address - Phone:407-249-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist