Provider Demographics
NPI:1053043455
Name:FROST, JASON ALLAN
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALLAN
Last Name:FROST
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 1:12 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2539
Mailing Address - Country:US
Mailing Address - Phone:559-720-2359
Mailing Address - Fax:
Practice Address - Street 1:12 SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2539
Practice Address - Country:US
Practice Address - Phone:559-720-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst