Provider Demographics
NPI:1205504735
Name:EAGLIN, JASMINE L (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:L
Last Name:EAGLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 224TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1702
Mailing Address - Country:US
Mailing Address - Phone:917-805-2746
Mailing Address - Fax:
Practice Address - Street 1:114-36 202ND STREET
Practice Address - Street 2:MINI BUILDING
Practice Address - City:ST. ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:718-776-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03079101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty