Healthcare Provider Details

I. General information

NPI: 1922233717
Provider Name (Legal Business Name): JASON B NESS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 THORNDALE LN
LAKE ZURICH IL
60047-2763
US

IV. Provider business mailing address

1232 THORNDALE LN
LAKE ZURICH IL
60047-2763
US

V. Phone/Fax

Practice location:
  • Phone: 847-812-4215
  • Fax:
Mailing address:
  • Phone: 847-812-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008078
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2043438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: