Provider Demographics
NPI:1902594666
Name:ADAMS, JASMINE MONIQUE (SLP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONIQUE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5569
Mailing Address - Country:US
Mailing Address - Phone:678-670-8264
Mailing Address - Fax:
Practice Address - Street 1:3771 HARVEST DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5569
Practice Address - Country:US
Practice Address - Phone:678-590-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist