Healthcare Provider Details

I. General information

NPI: 1306434972
Provider Name (Legal Business Name): KATHERINE EILEEN JASMON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LENHART RD
SPRINGFIELD IL
62711-9203
US

IV. Provider business mailing address

3000 LENHART RD
SPRINGFIELD IL
62711-9203
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-7150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: