Provider Demographics
NPI:1962016329
Name:MEYERS, JASMYN CAMILLE
Entity Type:Individual
Prefix:
First Name:JASMYN
Middle Name:CAMILLE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMYN
Other - Middle Name:CAMILLE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:530 W ARLINGTON PL APT GW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5995
Mailing Address - Country:US
Mailing Address - Phone:312-536-8821
Mailing Address - Fax:
Practice Address - Street 1:530 W ARLINGTON PL APT GW
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5995
Practice Address - Country:US
Practice Address - Phone:312-536-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist