Healthcare Provider Details

I. General information

NPI: 1639087588
Provider Name (Legal Business Name): JASON ASHCRAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 SONOMA AVE
SANTA ROSA CA
95404-4713
US

IV. Provider business mailing address

10907 RIO RUSO DR
WINDSOR CA
95492-8035
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3295
  • Fax:
Mailing address:
  • Phone: 707-799-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: