Provider Demographics
NPI:1376587915
Name:MADIGAN, JASON KYLE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:KYLE
Last Name:MADIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22247 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-5304
Mailing Address - Country:US
Mailing Address - Phone:228-452-1293
Mailing Address - Fax:
Practice Address - Street 1:127 GARY ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3503
Practice Address - Country:US
Practice Address - Phone:228-523-5186
Practice Address - Fax:228-523-4384
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC68951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical