Provider Demographics
NPI:1679271134
Name:STOTLER, JASON EDWARD MERLE
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD MERLE
Last Name:STOTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 E BAYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9620
Mailing Address - Country:US
Mailing Address - Phone:907-301-2050
Mailing Address - Fax:
Practice Address - Street 1:10020 E BAYWOOD WAY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9620
Practice Address - Country:US
Practice Address - Phone:907-301-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician