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General NPI Number Information
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NPI Number | 1528577632
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Entity Type | Individual
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Provider Name | JONAH WASEBERG PHD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 1100 E.55TH ST
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E 55TH ST
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City | CHICAGO
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State | IL
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Zip | 60615-5112
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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 | 178.012034
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.012034
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License Number State | IL
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