Provider Demographics
NPI:1245048842
Name:VALDEZ, JAZMINE A
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:A
Last Name:VALDEZ
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 1:2150 HUGHES RD UNIT 5102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6454
Mailing Address - Country:US
Mailing Address - Phone:815-508-4336
Mailing Address - Fax:
Practice Address - Street 1:2150 HUGHES RD UNIT 5102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-6454
Practice Address - Country:US
Practice Address - Phone:815-508-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician