Provider Demographics
NPI:1790593069
Name:PLASTER, JASMINE SUNSHINE DAYDREAM (SP61230270)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:SUNSHINE DAYDREAM
Last Name:PLASTER
Suffix:
Gender:F
Credentials:SP61230270
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:STOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1714 GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1213
Mailing Address - Country:US
Mailing Address - Phone:360-986-6528
Mailing Address - Fax:
Practice Address - Street 1:11509 HOLDEN RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-2810
Practice Address - Country:US
Practice Address - Phone:253-583-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP612302702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant