MEDICARE: JASMINE ALLEN LMSW

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	1041C0700X	Clinical Social Worker	6387	ND
2	1041C0700X	Clinical Social Worker	72636	MT
3	104100000X	Social Worker	69111	TX
4	1041C0700X	Clinical Social Worker	31888	MN

General Provider Information

NPI Number	:	1508587411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE ALLEN LMSW

Provider Business Mailing Address
First Line	:	25730 WILLARD PATH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-1113
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

Provider Business Practice Location Address
First Line	:	4700 S WASHINGTON ST STE G
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-8155
Country	:	US
Telephone Number	:	701-205-3000
Fax Number	:	701-732-2501

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	06/10/2026

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