Provider Demographics
NPI:1093589731
Name:WEST, JARED T
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:T
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ROMAN CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2590
Mailing Address - Country:US
Mailing Address - Phone:815-514-1662
Mailing Address - Fax:
Practice Address - Street 1:740 QUAIL RIDGE DR BLDG B
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6148
Practice Address - Country:US
Practice Address - Phone:630-581-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILW230-4388-7106106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician