Provider Demographics
NPI:1831938810
Name:PORTZ, JASMINE (MED, EDS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:PORTZ
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 WATTS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4842
Mailing Address - Country:US
Mailing Address - Phone:563-650-8017
Mailing Address - Fax:
Practice Address - Street 1:435 WATTS CT
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4842
Practice Address - Country:US
Practice Address - Phone:563-650-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool