Provider Demographics
NPI:1538303029
Name:BEYREIS, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BEYREIS
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 1:330 EAST LASALLE AVENUE
Mailing Address - Street 2:ROOM 338
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 EAST LASALLE AVENUE
Practice Address - Street 2:ROOM 338
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1546
Practice Address - Country:US
Practice Address - Phone:715-537-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43430300Medicaid