Healthcare Provider Details

I. General information

NPI: 1013398015
Provider Name (Legal Business Name): JASMINE PATRICIA NORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38807 ANN ARBOR RD STE 3
LIVONIA MI
48150-3896
US

IV. Provider business mailing address

154 GODFROY AVE APT 2
MONROE MI
48162-2724
US

V. Phone/Fax

Practice location:
  • Phone: 734-474-2958
  • Fax:
Mailing address:
  • Phone: 410-818-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11939851
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: