Provider Demographics
NPI:1104686195
Name:GOTT, JASLYN
Entity type:Individual
Prefix:
First Name:JASLYN
Middle Name:
Last Name:GOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 S LINDEN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5449
Mailing Address - Country:US
Mailing Address - Phone:810-919-8713
Mailing Address - Fax:
Practice Address - Street 1:2503 S LINDEN RD STE 150
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5449
Practice Address - Country:US
Practice Address - Phone:810-919-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty