Provider Demographics
NPI:1821881590
Name:SLOCUM, JASMINE (LBA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E LIEBER ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2617
Mailing Address - Country:US
Mailing Address - Phone:660-582-7113
Mailing Address - Fax:660-582-3493
Practice Address - Street 1:122 E LIEBER ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2617
Practice Address - Country:US
Practice Address - Phone:660-582-7113
Practice Address - Fax:660-582-3493
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024044438103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst