Provider Demographics
NPI:1619637659
Name:ELKASRI, JAZLYN
Entity Type:Individual
Prefix:
First Name:JAZLYN
Middle Name:
Last Name:ELKASRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 BOILERMAKER CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8412
Mailing Address - Country:US
Mailing Address - Phone:219-286-7043
Mailing Address - Fax:
Practice Address - Street 1:2803 BOILERMAKER CT
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8412
Practice Address - Country:US
Practice Address - Phone:219-286-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010954A104100000X
IN99107526A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker