Provider Demographics
NPI:1558554683
Name:JENKINS, JASMINE ANTOINETTE (MA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ANTOINETTE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E CHEVY CHASE DR
Mailing Address - Street 2:A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1714
Mailing Address - Country:US
Mailing Address - Phone:562-208-3868
Mailing Address - Fax:
Practice Address - Street 1:2102 E CHEVY CHASE DR
Practice Address - Street 2:A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1714
Practice Address - Country:US
Practice Address - Phone:562-208-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist