Healthcare Provider Details

I. General information

NPI: 1013458553
Provider Name (Legal Business Name): JASON B BRYANT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 MONDOVI RD
EAU CLAIRE WI
54701-6141
US

IV. Provider business mailing address

2925 MONDOVI RD
EAU CLAIRE WI
54701-6141
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-0238
  • Fax: 715-832-0771
Mailing address:
  • Phone: 715-832-0238
  • Fax: 715-832-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9495-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: