Provider Demographics
NPI:1437993458
Name:CAMPAGNONE, JASON A
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:CAMPAGNONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W HEMINGWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1763
Mailing Address - Country:US
Mailing Address - Phone:401-499-3168
Mailing Address - Fax:
Practice Address - Street 1:1021 W HEMINGWAY BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1763
Practice Address - Country:US
Practice Address - Phone:401-499-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1061376101YM0800X
RIMHC00066-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health