Jason L. Fairweather | |
553 Broadway Berlin WI 54923-1323 | |
(920) 204-6590 | |
Not Available |
Full Name | Jason L. Fairweather |
---|---|
Speciality | Counselor - Professional |
Location | 553 Broadway, Berlin, Wisconsin |
Authorized Official Name and Position | Jason Lee Fairweather (OWNER) |
Authorized Official Contact | 9202046590 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Jason L. Fairweather 553 Broadway Berlin WI 54923-1323 Ph: (920) 204-6590 | Jason L. Fairweather 553 Broadway Berlin WI 54923-1323 Ph: (920) 204-6590 |
NPI Number | 1225626963 |
---|---|
Provider Enumeration Date | 01/07/2021 |
Last Update Date | 01/12/2021 |
Certification Date | 01/12/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225626963 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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