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NPI Code Detail

MEDICARE: MRS. CHANELLE KRISTEN JASSO MS

MEDICARE: MRS. CHANELLE KRISTEN JASSO MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1154051209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHANELLE KRISTEN JASSO MS
Provider Business Mailing Address
First Line : 13248 SPRUCE RUN DR APT 205
Second Line :
City : NORTH ROYALTON
State : OH
Zip : 44133-7482
Country : US
Telephone Number : 480-202-8742
Fax Number :
Provider Business Practice Location Address
First Line : 90 N SUMMIT ST
Second Line :
City : AKRON
State : OH
Zip : 44308-1951
Country : US
Telephone Number : 234-571-9110
Fax Number : 234-571-9107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2022
Last Update Date : 06/13/2022

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