Provider Demographics
NPI:1881318913
Name:VAZQUEZ, MASON ALEXANDER I (MSW)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:ALEXANDER
Last Name:VAZQUEZ
Suffix:I
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FORWARD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2443
Mailing Address - Country:US
Mailing Address - Phone:608-579-0473
Mailing Address - Fax:608-280-2775
Practice Address - Street 1:2701 INTERNATIONAL LN STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3126
Practice Address - Country:US
Practice Address - Phone:608-268-6530
Practice Address - Fax:608-285-5646
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator