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General NPI Number Information
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NPI Number | 1013674043
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Entity Type | Individual
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Provider Name | JASON RYAN WEISS
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Gender | Male
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE STE 1040
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City | CHICAGO
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State | IL
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Zip | 60601-7421
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Country | US
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Telephone | 312-346-5156
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Fax | 312-284-6088
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Provider Business Mailing Address
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Address Line | 21509 W BARBARA CT
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City | KILDEER
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State | IL
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Zip | 60047-8611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1708017556
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License Number State | IL
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