Provider Demographics
NPI:1811127988
Name:DINGER, JASON D (LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:DINGER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 W RIFLEMAN ST # 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9000
Mailing Address - Country:US
Mailing Address - Phone:208-321-0634
Mailing Address - Fax:208-321-1082
Practice Address - Street 1:8050 W RIFLEMAN ST # 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9000
Practice Address - Country:US
Practice Address - Phone:208-321-0634
Practice Address - Fax:208-321-1082
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 29789101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002803300Medicaid