Provider Demographics
NPI:1851019434
Name:BAGGETT, JONATHON B
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:B
Last Name:BAGGETT
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 1:2447 STANFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8249
Mailing Address - Country:US
Mailing Address - Phone:919-699-7628
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7923
Practice Address - Country:US
Practice Address - Phone:925-338-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling