MEDICARE: JASON MATTHEW PACKARD

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1043086838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON MATTHEW PACKARD

Provider Business Mailing Address
First Line	:	6901 E ESCALANTE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-3239
Country	:	US
Telephone Number	:	253-209-1279
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3227
Country	:	US
Telephone Number	:	520-843-1910
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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Directions to “ JASON MATTHEW PACKARD ” Practice Location

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