Provider Demographics
NPI:1528597507
Name:NELSON, JASMINE (MS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:NELSON
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 1:4152 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8524
Mailing Address - Country:US
Mailing Address - Phone:701-364-9070
Mailing Address - Fax:701-364-9071
Practice Address - Street 1:4152 30TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8524
Practice Address - Country:US
Practice Address - Phone:701-364-9070
Practice Address - Fax:701-364-9071
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist