MEDICARE: MR. JOHN JASON CHASTAIN LICSW

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	1041C0700X	Clinical Social Worker	LW60480977	WA

General Provider Information

NPI Number	:	1457422917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JASON CHASTAIN LICSW

Provider Business Mailing Address
First Line	:	9825 SANDIFUR PKWY STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-6738
Country	:	US
Telephone Number	:	509-531-6698
Fax Number	:	509-402-1176

Provider Business Practice Location Address
First Line	:	9825 SANDIFUR PKWY STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-6738
Country	:	US
Telephone Number	:	509-531-6698
Fax Number	:	509-402-1176

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/02/2023

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