Provider Demographics
NPI:1518410679
Name:ABRAHAMZON, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ABRAHAMZON
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 1:1812 BRACKETT AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4677
Mailing Address - Country:US
Mailing Address - Phone:715-201-2381
Mailing Address - Fax:
Practice Address - Street 1:1812 BRACKETT AVE STE 6
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4677
Practice Address - Country:US
Practice Address - Phone:715-201-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNLPC0000004490101YP2500X
WI7969-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health