Provider Demographics
NPI:1902283005
Name:SPELLER, JASMYNE (M ED)
Entity Type:Individual
Prefix:MISS
First Name:JASMYNE
Middle Name:
Last Name:SPELLER
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-1636
Mailing Address - Country:US
Mailing Address - Phone:704-351-4517
Mailing Address - Fax:
Practice Address - Street 1:806 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1636
Practice Address - Country:US
Practice Address - Phone:704-351-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist