Provider Demographics
NPI:1386408151
Name:PAUL, JASMEN (LSW)
Entity type:Individual
Prefix:MS
First Name:JASMEN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TOWER DR APT B406
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1340
Mailing Address - Country:US
Mailing Address - Phone:773-757-9300
Mailing Address - Fax:
Practice Address - Street 1:3901 TOWER DR APT B406
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1340
Practice Address - Country:US
Practice Address - Phone:773-757-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13043071041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool