Provider Demographics
NPI:1487446175
Name:WILSON, JASMINE IMANI (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:IMANI
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 CLOUGH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3422
Mailing Address - Country:US
Mailing Address - Phone:614-314-4052
Mailing Address - Fax:
Practice Address - Street 1:1704 CLOUGH ST APT 110
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3422
Practice Address - Country:US
Practice Address - Phone:614-314-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20253031-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist