Healthcare Provider Details

I. General information

NPI: 1811348360
Provider Name (Legal Business Name): JASMINE RENEE SIMMONS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE RENEE MANRIQUEZ

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 NACORA ST
ROWLAND HEIGHTS CA
91748-3133
US

IV. Provider business mailing address

19500 NACORA ST
ROWLAND HEIGHTS CA
91748-3133
US

V. Phone/Fax

Practice location:
  • Phone: 909-444-0584
  • Fax:
Mailing address:
  • Phone: 909-444-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: