Provider Demographics
NPI:1639550775
Name:WEBER, JON (MASTER SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:MASTER SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 M 140 HWY
Mailing Address - Street 2:
Mailing Address - City:COVERT
Mailing Address - State:MI
Mailing Address - Zip Code:49043-9400
Mailing Address - Country:US
Mailing Address - Phone:269-621-5527
Mailing Address - Fax:
Practice Address - Street 1:6418 DEANS HILL RD
Practice Address - Street 2:
Practice Address - City:BERRIEN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49102-9750
Practice Address - Country:US
Practice Address - Phone:269-815-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical