Provider Demographics
NPI:1063541811
Name:GAGE, JONATHAN BRIAN (EDD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRIAN
Last Name:GAGE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 STONEHAM ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8032
Mailing Address - Country:US
Mailing Address - Phone:661-549-5699
Mailing Address - Fax:661-427-0220
Practice Address - Street 1:10319 STONEHAM ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314
Practice Address - Country:US
Practice Address - Phone:661-549-5699
Practice Address - Fax:661-427-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3210103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist