Provider Demographics
NPI:1134852023
Name:OWDLEY, JASMINE ALIMA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALIMA
Last Name:OWDLEY
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 1:3 BETHESDA METRO CTR STE 700
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6300
Mailing Address - Country:US
Mailing Address - Phone:240-292-8319
Mailing Address - Fax:
Practice Address - Street 1:3 BETHESDA METRO CTR STE 700
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6300
Practice Address - Country:US
Practice Address - Phone:240-292-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician