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General NPI Number Information
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NPI Number | 1962628586
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Entity Type | Individual
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Provider Name | JASON J. WASHBURN PH.D., ABPP
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/09/2011
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Provider Practice Location Address
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Address Line | 3047 N LINCOLN AVE SUITE #400
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City | CHICAGO
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State | IL
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Zip | 60657-4999
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Country | US
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Telephone | 773-904-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 3047 N LINCOLN AVE SUITE #400
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City | CHICAGO
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State | IL
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Zip | 60657-4999
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Country | US
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Telephone | 773-904-0445
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071006568
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071006568
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 071006568
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071006568
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License Number State | IL
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