Healthcare Provider Details

I. General information

NPI: 1447511993
Provider Name (Legal Business Name): JASMINE MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PIEDMONT DR
UPLAND CA
91784-1053
US

IV. Provider business mailing address

1215 PIEDMONT DR
UPLAND CA
91784-1053
US

V. Phone/Fax

Practice location:
  • Phone: 909-802-0916
  • Fax:
Mailing address:
  • Phone: 909-802-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: