Provider Demographics
NPI:1679674147
Name:CHIPPEAUX, JASON (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHIPPEAUX
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 1:1016 W SAGINAW DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-7002
Mailing Address - Country:US
Mailing Address - Phone:719-531-7785
Mailing Address - Fax:
Practice Address - Street 1:41 MONTEBELLO RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1379
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:719-542-9638
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000001331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical