1679970693 NPI number — MR. JASON RAY SCHWEITZER LICSW

Table of content: MR. JASON RAY SCHWEITZER LICSW (NPI 1679970693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679970693 NPI number — MR. JASON RAY SCHWEITZER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWEITZER
Provider First Name:
JASON
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679970693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 1ST AVE SW
Provider Second Line Business Mailing Address:
STE 300W
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55902-3389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-271-0467
Provider Business Mailing Address Fax Number:
507-540-1451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 1ST AVE SW
Provider Second Line Business Practice Location Address:
STE 300W
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55902-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-271-0467
Provider Business Practice Location Address Fax Number:
507-540-1451
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  20694 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1679970693 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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