Provider Demographics
NPI:1891838454
Name:HARRIS, JASON (RADC I)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 OFFSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4375
Mailing Address - Country:US
Mailing Address - Phone:608-371-7702
Mailing Address - Fax:
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1424
Practice Address - Country:US
Practice Address - Phone:608-371-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14134101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor