Provider Demographics
NPI:1215430913
Name:WILLIAMSON, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WILLIAMSON
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 1:562 W NORTHWEST HWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-0203
Mailing Address - Country:US
Mailing Address - Phone:760-484-8805
Mailing Address - Fax:
Practice Address - Street 1:562 W NORTHWEST HWY UNIT C
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-0203
Practice Address - Country:US
Practice Address - Phone:760-484-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2024-07-29
Deactivation Date:2024-06-20
Deactivation Code:
Reactivation Date:2024-07-25
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL12043473103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician