Provider Demographics
NPI:1497188106
Name:SWEAZY, JASON D (MS, BSN, BA, PMHNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:SWEAZY
Suffix:
Gender:M
Credentials:MS, BSN, BA, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W JUNIOR TER APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5098
Mailing Address - Country:US
Mailing Address - Phone:512-992-8808
Mailing Address - Fax:
Practice Address - Street 1:1457 N HALSTED ST UNIT B303
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2677
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:877-428-7891
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.524448163W00000X
NY757959163W00000X
CO198358163WP0807X
WY36768.1471363LP0808X
COAPN.0992019-NP363LP0808X
NY402523363LP0808X
IL277.002535363LP0808X
IL209.025514363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty