Provider Demographics
NPI:1891039905
Name:MAGILL, JASON R (LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:R
Last Name:MAGILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BAKER ST STE C
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2707
Mailing Address - Country:US
Mailing Address - Phone:608-849-5430
Mailing Address - Fax:858-225-7950
Practice Address - Street 1:110 BAKER ST STE C
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2707
Practice Address - Country:US
Practice Address - Phone:608-849-5430
Practice Address - Fax:858-225-7950
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005211101YP2500X
101YP2500X
WI7136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional