Provider Demographics
NPI:1922464197
Name:DODD, JASON EARL (LICSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EARL
Last Name:DODD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 114TH AVE SE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6956
Mailing Address - Country:US
Mailing Address - Phone:425-298-3527
Mailing Address - Fax:
Practice Address - Street 1:1621 114TH AVE SE
Practice Address - Street 2:SUITE 224
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6956
Practice Address - Country:US
Practice Address - Phone:425-298-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60481300104100000X
WALW608107741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker