MEDICARE: JASMINE SLOCUM LBA

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	103K00000X	Behavior Analyst	2024044438	MO

General Provider Information

NPI Number	:	1821881590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE SLOCUM LBA

Provider Business Mailing Address
First Line	:	122 E LIEBER ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2617
Country	:	US
Telephone Number	:	660-582-7113
Fax Number	:	660-582-3493

Provider Business Practice Location Address
First Line	:	122 E LIEBER ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2617
Country	:	US
Telephone Number	:	660-582-7113
Fax Number	:	660-582-3493

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

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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Directions to “ JASMINE SLOCUM LBA” Practice Location

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