Provider Demographics
NPI:1457552515
Name:SIMONSON, JASON LAMONTE (RD ELIGIBLE)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LAMONTE
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:RD ELIGIBLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 PACIFIC AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2015
Mailing Address - Country:US
Mailing Address - Phone:330-354-4872
Mailing Address - Fax:
Practice Address - Street 1:1404 PACIFIC AVE APT A1
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2015
Practice Address - Country:US
Practice Address - Phone:330-354-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education