Provider Demographics
NPI:1932502093
Name:HAYMOND, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:HAYMOND
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 1:617 E VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1187
Mailing Address - Country:US
Mailing Address - Phone:773-209-1617
Mailing Address - Fax:
Practice Address - Street 1:617 E VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1187
Practice Address - Country:US
Practice Address - Phone:773-209-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health