Provider Demographics
NPI:1134355639
Name:MOSER, JASON S (PHD)
Entity type:Individual
Prefix:PROF
First Name:JASON
Middle Name:S
Last Name:MOSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PHYSICS RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-5604
Mailing Address - Country:US
Mailing Address - Phone:517-355-2159
Mailing Address - Fax:517-353-1652
Practice Address - Street 1:316 PHYSICS RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-5604
Practice Address - Country:US
Practice Address - Phone:517-355-2159
Practice Address - Fax:517-353-1652
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical