Provider Demographics
NPI:1144039132
Name:CHUNG, JASMINE KEALOHA MAN-TSENG (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:KEALOHA MAN-TSENG
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7206
Mailing Address - Country:US
Mailing Address - Phone:800-645-6799
Mailing Address - Fax:253-476-6551
Practice Address - Street 1:14701 179TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-794-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61343237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist