Provider Demographics
NPI:1386522282
Name:ANDERSON, JAZMINE RENEE (BCABA, SCABA)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:RENEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCABA, SCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2211
Mailing Address - Country:US
Mailing Address - Phone:318-701-5864
Mailing Address - Fax:
Practice Address - Street 1:7932 SUMMA AVE STE B2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3736
Practice Address - Country:US
Practice Address - Phone:225-349-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-232106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst