Healthcare Provider Details

I. General information

NPI: 1306594411
Provider Name (Legal Business Name): JASPER COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S VAN BUREN ST
NEWTON IL
62448-1727
US

IV. Provider business mailing address

106 EDWARDS ST
NEWTON IL
62448-1736
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-4154
  • Fax:
Mailing address:
  • Phone: 618-783-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEANNIE JOHNSON
Title or Position: DIRECTOR OF BEHAVIORAL HEALTH
Credential: MS, LCPC, CADC
Phone: 618-783-4154