Provider Demographics
NPI:1033411939
Name:KANTROWITZ, JASON STUART (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:STUART
Last Name:KANTROWITZ
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10042 N. BROOKDALE DR.
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5702
Mailing Address - Country:US
Mailing Address - Phone:414-534-2979
Mailing Address - Fax:262-292-8184
Practice Address - Street 1:10042 N. BROOKDALE DR.
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5702
Practice Address - Country:US
Practice Address - Phone:414-534-2979
Practice Address - Fax:262-292-8184
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-27
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4412-125101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator