Most Relevant Information
Provider Data
| NPI Number: | 1003336397 |
| Provider Name: | JADEN ELIJAH CHAMPION |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 91813 |
Most Important Dates
| Enumeration Date: | 06/27/2017 |
| Last Updated: | 07/19/2022 |
Provider Practice Location
4785 N FIRST ST
FRESNO
CA
93726
Practice Location Phone/Fax
| Phone: | 5594484879 |
| Fax: |
Provider Mailing Location
4785 N FIRST ST
FRESNO
CA
93726
Provider Mailing Phone/Fax
| Phone: | 5594484879 |
| Fax: |