Provider Demographics
NPI:1255821989
Name:FITZSIMMONS, JASMINE MONET
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONET
Last Name:FITZSIMMONS
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 1:14905 W LAMOILLE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4408
Mailing Address - Country:US
Mailing Address - Phone:623-824-5483
Mailing Address - Fax:
Practice Address - Street 1:38201 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:AZ
Practice Address - Zip Code:85354-7301
Practice Address - Country:US
Practice Address - Phone:623-474-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA111662355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant