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NPI Code Detail

MEDICARE: JASMINE WAYNE

MEDICARE: JASMINE WAYNE
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
1101YP2500XProfessional Counselor6401017725MI

General Provider Information

NPI Number : 1215578745
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE WAYNE
Provider Business Mailing Address
First Line : 79 W ALEXANDRINE ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2015
Country : US
Telephone Number : 313-831-5535
Fax Number : 313-831-2608
Provider Business Practice Location Address
First Line : 79 W ALEXANDRINE ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2015
Country : US
Telephone Number : 313-831-5535
Fax Number : 313-831-2608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2019
Last Update Date : 01/15/2026

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Directions to “ JASMINE WAYNE ” Practice Location

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