Provider Demographics
NPI:1285483792
Name:CRUZ, JASMINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 LOCH NESS RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8224
Mailing Address - Country:US
Mailing Address - Phone:201-788-8526
Mailing Address - Fax:
Practice Address - Street 1:6925 OLD WATERLOO RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6529
Practice Address - Country:US
Practice Address - Phone:410-313-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist