Provider Demographics
NPI:1710743844
Name:GONZALEZ, JASMINE BIANCA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:BIANCA
Last Name:GONZALEZ
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 1:3341 AUTUMN CHASE WAY NE APT 104
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1677
Mailing Address - Country:US
Mailing Address - Phone:541-525-5368
Mailing Address - Fax:
Practice Address - Street 1:3341 AUTUMN CHASE WAY NE APT 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1677
Practice Address - Country:US
Practice Address - Phone:541-525-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician