Provider Demographics
NPI:1376890368
Name:MARSHALL, JASON A (BCBA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 N FINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1516
Mailing Address - Country:US
Mailing Address - Phone:559-515-6485
Mailing Address - Fax:
Practice Address - Street 1:2307 N FINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1516
Practice Address - Country:US
Practice Address - Phone:559-515-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst