Provider Demographics
NPI:1083087068
Name:DALTON, JASON JEFFERY ROY (MS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JEFFERY ROY
Last Name:DALTON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8088
Mailing Address - Country:US
Mailing Address - Phone:909-435-0212
Mailing Address - Fax:
Practice Address - Street 1:410 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8088
Practice Address - Country:US
Practice Address - Phone:909-435-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst