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NPI Code Detail

MEDICARE: JASON RYAN WEISS

MEDICARE: JASON RYAN WEISS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1708017556IL

General Provider Information

NPI Number : 1013674043
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON RYAN WEISS
Provider Business Mailing Address
First Line : 21509 W BARBARA CT
Second Line :
City : KILDEER
State : IL
Zip : 60047-8611
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 180 N MICHIGAN AVE STE 1040
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7421
Country : US
Telephone Number : 312-346-5156
Fax Number : 312-284-6088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2021
Last Update Date : 11/24/2021

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Directions to “ JASON RYAN WEISS ” Practice Location

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