Jasmine Alicia Wallace, B.S.

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

145 Maple Ave
Red Bank, NJ 07701-1717

Phone

(732) 747-9660

Fax

(732) 224-1396

NPI assigned

Nov 29, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

Interoperability endpoints

• Direct secure messaging: jasmine.wallace.p2@direct.ucpnyc.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194892620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 SEWALL AVE APT 5R",
            "city": "ASBURY PARK",
            "state": "NJ",
            "postal_code": "077126540",
            "telephone_number": "732-747-9660",
            "fax_number": "732-224-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MAPLE AVE",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011717",
            "telephone_number": "732-747-9660",
            "fax_number": "732-224-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JASMINE",
        "middle_name": "ALICIA",
        "name_prefix": "Ms.",
        "credential": "B.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Wagner, DMD
• Dennis Waite, PT, DPT, CSCS
• Walgreen Co
• Walgreen Co .
• Carole A Wallace, D.D.S.
• Edna Ruth Walsh, MSW LCSW
• Elizabeth Dianne Walter, LCSW
• Shannon Wanless, FNP- BC
• Megan Washburn
• Maureen Waters, LCSW LMFT

• Counselor in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.