Provider Demographics
NPI:1891675831
Name:AVILES, JASMINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 ROAN CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-5423
Mailing Address - Country:US
Mailing Address - Phone:650-255-4581
Mailing Address - Fax:
Practice Address - Street 1:1475 HARLAN DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5248
Practice Address - Country:US
Practice Address - Phone:925-855-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist