MEDICARE: JASMINE NICOLE RIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	124664	TX

General Provider Information

NPI Number	:	1205795515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE NICOLE RIDGE

Provider Business Mailing Address
First Line	:	202 LOCHWOOD DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-7356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E LAMAR BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7354
Country	:	US
Telephone Number	:	972-237-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ JASMINE NICOLE RIDGE ” Practice Location

Language	Start Address	Practice Location

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