Healthcare Provider Details

I. General information

NPI: 1295656627
Provider Name (Legal Business Name): JASMINE KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 360
GARDENA CA
90248-4338
US

IV. Provider business mailing address

6375 WEDGEWOOD TRCE
TUCKER GA
30084-1391
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-8184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA1768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: