MEDICARE: JASMINE WEARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver
2	320800000X	Mental Illness Community Based Residential Treatment Facility	WI
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	WI
4	251S00000X	Community/Behavioral Health Agency	WI

General Provider Information

NPI Number	:	1396480158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE WEARY

Provider Business Mailing Address
First Line	:	5322 N DEXTER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5040
Country	:	US
Telephone Number	:	414-400-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 N DEXTER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5040
Country	:	US
Telephone Number	:	414-400-3199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	04/08/2026

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Directions to “ JASMINE WEARY ” Practice Location

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