Provider Demographics
NPI:1134495583
Name:WARSHAWSKY, JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:WARSHAWSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-0025
Mailing Address - Country:US
Mailing Address - Phone:347-688-4778
Mailing Address - Fax:
Practice Address - Street 1:103 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2601
Practice Address - Country:US
Practice Address - Phone:347-688-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical