Provider Demographics
NPI:1649961459
Name:GRIDER-MUNSON, CHASE AUSTIN
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:AUSTIN
Last Name:GRIDER-MUNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:AUSTIN
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 ALDER TREE WAY APT 161
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3954
Mailing Address - Country:US
Mailing Address - Phone:530-945-4303
Mailing Address - Fax:
Practice Address - Street 1:354 CERNON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4502
Practice Address - Country:US
Practice Address - Phone:707-685-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician