Individual
MR. JASON KYLE MADIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
127 GARY ST, GULFPORT, MS 39503-3503
(228) 523-5186
(228) 523-4384
Mailing address
22247 EVANGELINE DR, PASS CHRISTIAN, MS 39571-5304
(228) 452-1293
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6895
MS
Other
Enumeration date
06/15/2006
Last updated
07/08/2007
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