Provider Demographics
NPI:1487299541
Name:JASSO, JAVIER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:JASSO
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MANAYUNK AVE APT 126
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5124
Mailing Address - Country:US
Mailing Address - Phone:209-613-0868
Mailing Address - Fax:
Practice Address - Street 1:3901 MANAYUNK AVE APT 126
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-5124
Practice Address - Country:US
Practice Address - Phone:209-613-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist