Provider Demographics
NPI:1376256172
Name:CHRISTMAN, JASON A (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:CHRISTMAN
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 BRINDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7227
Mailing Address - Country:US
Mailing Address - Phone:815-409-8710
Mailing Address - Fax:
Practice Address - Street 1:16614 W 159TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8008
Practice Address - Country:US
Practice Address - Phone:630-949-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106754101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor