Provider Demographics
NPI:1306490172
Name:BRESCIA, JASON
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:BRESCIA
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 1:385 BRITTANY CT APT B
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3653
Mailing Address - Country:US
Mailing Address - Phone:847-767-0015
Mailing Address - Fax:
Practice Address - Street 1:9241 S ILLINOIS RTE 31
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156
Practice Address - Country:US
Practice Address - Phone:847-854-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-08-18
Deactivation Date:2020-07-31
Deactivation Code:
Reactivation Date:2020-08-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILXOX831289317OtherBLUE CROSS/SHIELD