Healthcare Provider Details

I. General information

NPI: 1356275929
Provider Name (Legal Business Name): JAZMYN JONES WILKINS BT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19800 AQUASCO RD
AQUASCO MD
20608-2102
US

IV. Provider business mailing address

19800 AQUASCO RD
AQUASCO MD
20608-2102
US

V. Phone/Fax

Practice location:
  • Phone: 216-236-9004
  • Fax:
Mailing address:
  • Phone: 216-236-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: