| 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 |
N/a Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 141 W Huron St, Berlin, WI 54923 Phone: 920-290-0107 | |
Lakeside Neurocare Limited Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 191 Memorial Dr, Berlin, WI 54923 Phone: 920-223-5580 Fax: 920-223-5592 |