Provider Demographics
NPI:1871201277
Name:WILSON, JASMINE LYNN (SLP, CF)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP, CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 HIGH ST STE 701
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3025
Mailing Address - Country:US
Mailing Address - Phone:800-337-5965
Mailing Address - Fax:
Practice Address - Street 1:184 HIGH ST STE 701
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3025
Practice Address - Country:US
Practice Address - Phone:800-337-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist