Provider Demographics
NPI:1194105106
Name:WANG, JASMIN WU (MA, SLP)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:WU
Last Name:WANG
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:13719 174TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6502
Mailing Address - Country:US
Mailing Address - Phone:650-272-9046
Mailing Address - Fax:
Practice Address - Street 1:13719 174TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-6502
Practice Address - Country:US
Practice Address - Phone:650-272-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9279235Z00000X
WA60568539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist