Provider Demographics
NPI:1366810939
Name:GAITHER, JASMINE MONIQUE (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONIQUE
Last Name:GAITHER
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 1:961 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1790
Mailing Address - Country:US
Mailing Address - Phone:678-575-8090
Mailing Address - Fax:
Practice Address - Street 1:961 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1790
Practice Address - Country:US
Practice Address - Phone:678-575-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist