Provider Demographics
NPI:1780931683
Name:COHEN, JASON ALAN
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALAN
Last Name:COHEN
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 1:241 GOLF MILL CTR
Mailing Address - Street 2:SUITE 201-203
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-699-9757
Mailing Address - Fax:847-699-5037
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 201-203
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-699-9757
Practice Address - Fax:847-699-5037
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist