Provider Demographics
NPI:1871382184
Name:VIERCK, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:VIERCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 MILTON AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9145
Mailing Address - Country:US
Mailing Address - Phone:608-302-6395
Mailing Address - Fax:
Practice Address - Street 1:4465 MILTON AVE STE 107
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9145
Practice Address - Country:US
Practice Address - Phone:608-302-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor