Healthcare Provider Details

I. General information

NPI: 1811127988
Provider Name (Legal Business Name): JASON D DINGER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 W RIFLEMAN ST # 100
BOISE ID
83704-9000
US

IV. Provider business mailing address

8050 W RIFLEMAN ST # 100
BOISE ID
83704-9000
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-0634
  • Fax: 208-321-1082
Mailing address:
  • Phone: 208-321-0634
  • Fax: 208-321-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW 29789
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: