Provider Demographics
NPI:1356701817
Name:LEDFORD, JASON HEATH (LCSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:HEATH
Last Name:LEDFORD
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:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1377
Mailing Address - Country:US
Mailing Address - Phone:808-291-9789
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON ROAD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-6016
Practice Address - Country:US
Practice Address - Phone:808-291-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW40471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN