Provider Demographics
NPI:1205654811
Name:RODRIGUES, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 BREN RD E UNIT 146
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-0035
Mailing Address - Country:US
Mailing Address - Phone:612-229-1071
Mailing Address - Fax:
Practice Address - Street 1:10101 BREN RD E UNIT 146
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-0035
Practice Address - Country:US
Practice Address - Phone:612-229-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty