MEDICARE: JASMINE PORTZ M.ED, ED.S

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
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1831938810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE PORTZ M.ED, ED.S

Provider Business Mailing Address
First Line	:	435 WATTS CT
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4842
Country	:	US
Telephone Number	:	563-650-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 WATTS CT
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4842
Country	:	US
Telephone Number	:	563-650-8017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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