Provider Demographics
NPI:1720228521
Name:ARTZ, JASON DANIEL
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:ARTZ
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 1:619 RIVER ST STE F
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9188
Mailing Address - Country:US
Mailing Address - Phone:608-445-4286
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST STE F
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:608-445-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health