Provider Demographics
NPI:1336415025
Name:WINSLOW, JASON TOBY (ACSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:TOBY
Last Name:WINSLOW
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-1257
Mailing Address - Country:US
Mailing Address - Phone:209-464-4524
Mailing Address - Fax:209-464-2272
Practice Address - Street 1:540 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2117
Practice Address - Country:US
Practice Address - Phone:209-464-4524
Practice Address - Fax:209-464-2272
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW 32307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health