Provider Demographics
NPI:1114405248
Name:DASO, JESSE ROBERT (LPC, SAC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ROBERT
Last Name:DASO
Suffix:
Gender:M
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 W ZEDLER LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5426
Mailing Address - Country:US
Mailing Address - Phone:262-365-3681
Mailing Address - Fax:
Practice Address - Street 1:1615 W ZEDLER LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5426
Practice Address - Country:US
Practice Address - Phone:262-365-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16240-131101YA0400X
WI6926-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)