Provider Demographics
NPI:1922617711
Name:FIELDS, JASMINE (MS/CCC SLP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MS/CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-4142
Mailing Address - Country:US
Mailing Address - Phone:262-554-5006
Mailing Address - Fax:
Practice Address - Street 1:4214 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-4142
Practice Address - Country:US
Practice Address - Phone:262-554-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist